TUGAS KEPERAWATAN JIWA

“ASUHAN KEPERAWATAN SEHAT JIWA REMAJA”

DI SUSUN OLEH :

1. Putri Rahayu 20210109301

2. Qothrunnadaa 20210109247
3. Ria Elfama 20210109594
4. Rifqi Nurul Aini 20210109254
5. Riski Yulia Santika 20210109148
6. Sari Apriliyana S 20210109129

POLITEKNIK KESEHATAN KEMENKES SURAKARTA

JURUSAN KEPERAWATAN
PROGRAM PROFESI NERS
2020
 KATA PENGANTAR

Puji syukur kita panjatkan kehadirat Tuhan Yang Maha Esa, karena atas
berkat rahmat dan hidayah–Nya kami dapat menyusun dan menyelesaikan
“Asuhan Keperawatan Sehat Jiwa Remaja” ini tepat pada waktu yang telah
ditentukan. Makalah ini diajukan guna memenuhi tugas yang diberikan dosen mata
kuliah Keperawatan Jiwa.
Pada kesempatan ini, kami juga berterima kasih atas bimbingan dan
masukan dari semua pihak yang telah memberi kami bantuan wawasan untuk dapat
menyelesaikan makalah ini baik itu secara langsung maupun tidak langsung.
Kami menyadari isi makalah ini masih jauh dari kategori sempurna, baik dari
segi kalimat, isi maupun dalam penyusunan. Oleh karena itu, kritik dan saran yang
membangun dari dosen mata kuliah yang bersangkutan, sangat kami harapkan demi
kesempurnaan makalah ini.

Surakarta, 31 Agustus 2020

Penulis

i
 DAFTAR ISI

KATA PENGANTAR ............................................................................................. i

DAFTAR ISI...........................................................................................................ii

BAB I PENDAHULUAN

A. Latar Belakang.......................................................................................... 1

B. Rumusan Masalah .................................................................................... 3

C. Tujuan................................................................................................ ........3

BAB II TINJAUAN PUSTAKA

A. Konsep Remaja ........................................................................................ 4

B. Kesehatan Jiwa Pada Remaja ................................................................. 11

BAB III KONSEP ASUHAN KEPERAWATAN JIWA PADA REMAJA

A. Pengkajian ..............................................................................................15
B. Diagnosa ..................................................................................................15
C. Intevensi ..................................................................................................16
D. Implementasi ..........................................................................................17
E. Evaluasi ...................................................................................................17

BAB IV PENUTUP

A. Kesimpulan .............................................................................................18
B. Saran .......................................................................................................18

DAFTAR PUSTAKA

LAMPIRAN

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 BAB I
LATAR BELAKANG

A. Latar Belakang
Kesehatan jiwa adalah kondisi dimana seorang indvidu dapat berkembang
secara fisik, mental, spiritual dan sosial sehingga individu tersebut menyadari
kemampuan sendiri, dapat mengatasi tekanan, dapat bekerja secara produktif,
dan mampu memberikan konstribusi untuk komunitasnya (UU RI nomor 18
tentang kesehatan jiwa). Menurut Keliat (2014), kesehatan jiwa suatu kondisi
mental sejahtera yang harmonis dan produktif dengan ciri menyadari
sepenuhnya kemampuan dirinya, mampu menghadapi stress kehidupan dengan
wajar, dapat berperan serta dalam lingkungan hidup, menerima dengan baik
apa yang ada pada dirinya dan merasa nyaman dengan orang lain.
Kesehatan jiwa mencakup disetiap perkembangan individu di mulai sejak
dalam kandungan kemudian dilanjutkan ke tahap selanjutnya dimulai dari bayi
(0-18 bulan), masa toddler (1,5-3 tahun), masa anak-anak awal atau pra sekolah
(3-6 tahun), usia sekolah (6-12 tahun), remaja (12-18 tahun), dewasa muda (18-
35 tahun), dewasa tengah (35-65 tahun), sehingga dewasa akhir (>65 tahun)
(Wong, D.L, 2009).
Remaja adalah adalah masa transisi perkembangan antara masa kanak-
kanak dan dewasa yang pada umumnya dimulai pada usia 12 atau 13 tahun dan
berakhir pada usia akhir belasan tahun atau awal dua puluhan tahun (Keliat,
2014). Remaja memiliki beberapa tugas perkembangan yang harus dipenuhi.
Masa Remaja (adolescence) ditandai adanya kecenderungan identity- Identity
Confusion. Sebagai persiapan ke arah kedewasaan didukung pula oleh
kemampuan yang dimilikinya dia berusaha untuk membentuk dan
memperlihatkan identitas diri, ciri-ciri yang khas dari dirinya. Dorongan
membentuk dan memperlihatkan identitas diri ini, pada para remaja sering
sekali sangat ekstrim dan berlebihan, sehingga tidak jarang dipandang oleh
lingkungannya sebagai penyimpangan atau kenakalan. Dorongan
pembentukan identitas diri yang kuat di satu pihak, sering diimbangi oleh rasa

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setia kawan dan toleransi yang besar terhadap kelompok sebayanya. Di antara
kelompok sebaya mereka mengadakan pembagian peran, dan seringkali
mereka sangat patuh terhadap peran yang diberikan kepada masing-masing
anggota (Potter & Perry, 2012).
Masalah kesehatan jiwa pada remaja perlu menjadi perhatian utama dalam
setiap upaya peningkatan sumber daya manusia, dimana remaja merupakan
generasi yang perlu disiapkan untuk aset kekuatan bangsa. Kejadian gangguan
kesehatan jiwa pada anak dan remaja cenderung meningkat sejalan dengan
permasalahan kehidupan yang semakin kompleks (Hamid, 2009).
Potter & Perry (2012) memaparkan bahwa semua tugas perkembangan pada
masa remaja dipusatkan pada penanggulangan sikap dan pola perilaku yang
kekanak-kanakan dan mengadakan persiapan untuk menghadapi masa dewasa.
Menurut Ali (2010) tugas perkembangan masa remaja difokuskan kepada
upaya meninggalkan sikap dan perilaku kekanak-kanakan serta berusaha untuk
mencapai kemampuan bersikap dan berperilaku secara dewasa. Tugas
perkembangan remaja diantaranya mencapai hubungan baru dan yang lebih
matang dengan teman sebaya baik pria maupun wanita, mencari peran sosial
pria dan wanita serta menerima keadaan fisiknya dan menggunakan tubuhnya
secara efektif (Potter & Perry, 2012). Remaja juga mengalami perubahan-
perubahan pada dirinya salah satunya adalah perubahan pada kejiwaanya.
Perubahan kejiwaan pada masa remaja biasanya berupa perubahan emosi
dimana remaja mudah bereaksi bahkan agresif terhadap gangguan atau
rangsangan luar yang mempengaruhinya, hal ini menyebabkan mudahnya
terjadi perkelahian. Remaja juga cendrung tidak patuh pada orang tua dan lebih
senang pergi bersama dengan temannya daripada harus tinggal di rumah. Selain
itu remaja juga cenderung ingin mengetahui hal-hal baru sehingga timbullah
prilaku ingin mencoba-coba (Widyastuti, 2009).

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B. Masalah
Bagaimana asuhan keperawatan kesehatan jiwa yang baik dan benar terhadap
remaja ?

C. Tujuan
Mengetahui asuhan keperawatan kesehatan jiwa pada remaja yang baik dan
benar.

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 BAB II
KAJIAN TEORI
A. Konsep Remaja
1. Definisi
Kata “remaja” berasal dari bahasa Latin adolescene berarti to grow
atau to grow maturity (Golinko, 1984, Rice, 1990 dalam Putro, 2017).
Badan Kesehatan Dunia (WHO) memberikan batasan mengenai
siapa remaja secara konseptual. Dikemukakannya oleh WHO ada tiga
kriteria yang digunakan; biologis, psikologis, dan sosial ekonomi, yakni:
a. Individu yang berkembang saat pertama kali ia menunjukkan tanda-
tanda seksual sekundernya sampai saat ia mencapai kematangan
seksual
b. Individu yang mengalami perkembangan psikologis dan pola
identifikasi dari anak-anak menjadi dewasa
c. Terjadi peralihan dari ketergantungan sosial ekonomi yang penuh
kepada keadaan yang lebih mandiri. (Wirawan, 2002 dalam Putro,
2017).
Masa remaja merupakan suatu fase perkembangan antara masa
kanak – kanak dan masa dewasa, berlangsung antara usia 10 – 19 tahun.
Masa remaja terdiri dari remaja awal ( 10 – 14 tahun ), masa remaja
pertengahan ( 14- 17 tahun )dan masa remaja akhir (17 – 19 tahun). Pada
masa remaja terjadi banyak perubahan baik biologis, psikologis maupun
sosial (Kusumawati, F, 2010 dalam Nasriati, 2011).

2. Ciri-ciri remaja (Hurlock, 1993 dalam Putro, 2017)

a. Masa remaja sebagai periode yang penting
Pada periode remaja, baik akibat langsung maupun akibat jangka
panjang tetaplah penting. Perkembangan fisik yang begitu cepat
disertai dengan cepatnya perkembangan mental, terutama pada masa
awal remaja. Semua perkembangan ini menimbulkan perlunya
penyesuaian mental serta perlunya membentuk sikap, nilai, dan minat
baru
b. Masa remaja sebagai periode peralihan
Pada fase ini, remaja bukan lagi seorang anak dan bukan juga
orang dewasa. Kalau remaja berperilaku seperti anak-anak, ia akan
diajari untuk bertindak sesuai dengan umurnya. Kalau remaja
berusaha berperilaku sebagaimana orang dewasa, remaja seringkali
dituduh terlalu besar ukurannya dan dimarahi karena mencoba
bertindak seperti orang dewasa. Di lain pihak, status remaja yang tidak
jelas ini juga menguntungkan karena status memberi waktu kepadanya
untuk mencoba gaya hidup yang berbeda dan menentukan pola
perilaku, nilai, dan sifat yang paling sesuai bagi dirinya.
c. Masa remaja sebagai periode perubahan
Tingkat perubahan dalam sikap dan perilaku selama masa remaja
sejajar dengan tingkat perubahan fisik. Selama awal masa remaja,
ketika perubahan fisik terjadi dengan pesat, perubahan perilaku dan
sikap juga berlangsung pesat. Kalau perubahan fisik menurun, maka
perubahan sikap dan perilaku juga menurun.
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d. Masa remaja sebagai usia bermasalah
Setiap periode perkembangan mempunyai masalahnya sendiri-
sendiri, namun masalah masa remaja sering menjadi persoalan yang
sulit diatasi baik oleh anak laki-laki maupun anak perempuan.
Ketidakmampuan mereka untuk mengatasi sendiri masalahnya
menurut cara yang mereka yakini, banyak remaja akhirnya
menemukan bahwa penyelesaiannya tidak selalu sesuai dengan
harapan mereka.
e. Masa remaja sebagai masa mencari identitas
Pada tahun-tahun awal masa remaja, penyesuaian diri terhadap
kelompok masih tetap penting bagi anak laki-laki dan perempuan.
Lambat laun mereka mulai mendambakan identitas diri dan tidak puas
lagi dengan menjadi sama dengan teman-teman dalam segala hal,
seperti sebelumnya. Status remaja yang mendua ini menimbulkan
suatu dilema yang menyebabkan remaja mengalami “krisis identitas”
atau masalah-masalah identitas-ego pada remaja.
f. Masa remaja sebagai usia yang menimbulkan ketakutan
Anggapan stereotip budaya bahwa remaja suka berbuat semaunya
sendiri atau “semau gue”, yang tidak dapat dipercaya dan cenderung
berperilaku merusak, menyebabkan orang dewasa yang harus
membimbing dan mengawasi kehidupan remaja yang takut
bertanggung jawab dan bersikap tidak simpatik terhadap perilaku
remaja yang normal.
g. Masa remaja sebagai masa yang tidak realistic
Masa remaja cenderung memandang kehidupan melalui kacamata
berwarna merah jambu. Ia melihat dirinya sendiri dan orang lain
sebagaimana yang ia inginkan dan bukan sebagaimana adanya,
terlebih dalam hal harapan dan cita-cita. Harapan dan cita-cita yang
tidak realistik ini, tidak hanya bagi dirinya sendiri tetapi juga bagi
keluarga dan teman-temannya, menyebabkan meningginya emosi
yang merupakan ciri dari awal masa remaja. Remaja akan sakit hati
dan kecewa apabila orang lain mengecewakannya atau kalau ia tidak
berhasil mencapai tujuan yang telah ditetapkannya sendiri.
h. Masa remaja sebagai ambang masa dewasa
Semakin mendekatnya usia kematangan yang sah, para remaja
menjadi gelisah untuk meninggalkan stereotip belasan tahun dan
untuk memberikan kesan bahwa mereka sudah hampir dewasa.
Berpakaian dan bertindak seperti orang dewasa ternyata belumlah
cukup. Oleh karena itu, remaja mulai memusatkan diri pada perilaku
yang dihubungkan dengan status dewasa, yaitu merokok,
minumminuman keras, menggunakan obat-obatan, dan terlibat dalam
perbuatan seks bebas yang cukup meresahkan. Mereka menganggap
bahwa perilaku yang seperti ini akan memberikan citra yang sesuai
dengan yang diharapkan mereka.
Selanjutnya, Jahja (2011) dalam Putro (2017) mengemukakan
bahwa masa remaja adalah suatu masa perubahan. Pada masa remaja
terjadi perubahan yang cepat baik secra fisik, maupun psikologis. Ada
beberapa perubahan yang terjadi selama masa remaja yang sekaligus
sebagai ciri-ciri masa remaja yaitu :
a. Peningkatan emosional yang terjadi secara cepat pada masa remaja

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 awal yang dikenal sebagai masa storm & stress. Peningkatan
emosional ini merupakan hasil dari perubahan fisik terutama hormon
yang terjadi pada masa remaja. Dari segi kondisi sosial, peningkatan
emosi ini merupakan tanda bahwa remaja berada dalam kondisi bari
yang berbeda dari masa-masa yang sebelumnya. Pada fase ini banyak
tuntutan dan tekanan yang ditujukan kepada remaja, misalnya mereka
diharapkan untuk tidak lagi bertingkah laku seperti anak-anak, mereka
harus lebih mandiri, dan bertanggung jawab. Kemandirian dan
tanggung jawab ini akan terbentuk seiring berjalannya waktu, dan
akan tampak jelas pada remaja akhir yang duduk di awal-awal masa
kuliah di Perguruan Tinggi.
b. Perubahan yang cepat secara fisik juga disertai dengan kematangan
seksual. Terkadang perubahan ini membuat remaja merasa tidak yakin
akan diri dan kemampuan mereka sendiri. Perubahan fisik yang terjadi
secara cepat, baik perubahan internal seperti sistem sirkulasi,
pencernaan, dan sistem respirasi maupun perubahan eksternal seperti
tinggi badan, berat badan, dan proporsi tubuh sangat berpengaruh
terhadap konsep diri remaja.
c. Perubahan dalam hal yang menarik bagi dirinya dan hubungannya
dengan orang lain. Selama masa remaja banyak hal-hal yang menarik
bagi dirinya dibawa dari masa kanak-kanak digantikan dengan hal
menarik yang baru dan lebih matang. Hal ini juga dikarenakan adanya
tanggung jawab yang lebih besar pada masa remaja, maka remaja
diharapkan untuk dapat mengarahkan ketertarikan mereka pada hal-
hal yang lebih penting. Perubahan juga terjadi dalam hubungannya
dengan orang lain. Remaja tidak lagi berhubungan hanya dengan
individu dari jenis kelamin yang sama, tetapi juga dengan lawan jenis,
dan dengan orang dewasa.
d. Perubahan nilai, di mana apa yang mereka anggap penting pada masa
kanak-kanak menjadi kurang penting, karena telah mendekati dewasa.
e. Kebanyakan remaja bersikap ambivalen dalam menghadapi perubahan
yang terjadi. Di satu sisi mereka menginginkan kebebasan, tetapi di
sisi lain mereka takut akan tanggung jawab yang menyertai kebebasan
itu, serta meragukan kemampuan mereka sendiri untuk memikul
tanggung jawab itu.

3. Perkembangan masa remaja (Nastriati, 2011)

a. Perkembangan Fisik
Perubahan – perubahan fisik merupakan gejala primer dalam
pertumbuhan masa remaja yang berdampak terhadap perubahan-
perubahan psikologis
1) Anak Perempuan
Perkembangan fisik anak perempuan mulai berkembang
pada usia 10,5 tahun dan paling cepat pada usia 12
tahun.Perkembangan fisik pada anak perempuan meliputi :
a) Pertumbuhan fisik yang pesat ( usia 10 – 11 tahun )
b) Pertumbuhan payudara ( 10 – 11 tahun )
c) Tumbuhnya rambut pubis (10 – 11 tahun ), dan rambut ketiak
( 12 – 13 tahun )
d) Pengeluaran sekret vagina ( 10 – 13 tahun )

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 e) Produksi kelenjar keringat ( 12-13 tahun)
f) Menstruasi ( 11 – 14 tahun ).
Perkembangan fisik pada anak perempuan nampaknya
tidak sejalan dengan pematangan psikologisnya. Payudara yang
tumbuh lebih dini seringkali menimbulkan rasa malu karena
sudah diperlakukan sebagai orang dewasa padahal remaja ini
belum siap untuk menghadapinya.
2) Anak Laki-laki
Perkembangan fisik pada anak laki- laki 2 tahun lebih
lambat mulainya,namun akhirnya anak laki- laki bertambah 12–
15cm dalam 1 tahun hingga pada usia 13 sampai menjelang 14
tahun. Perkembangan fisik pada anak laki-laki meliputi:
a) pertumbuhan fisik yang pesat (12-13 tahun)
b) pertumbuhan testis dan skrotum (11-12tahun )
c) perkembangan penis (12-13tahun)
d) terjadi ejakulasi (13-14tahun)
e) pertumbuhan rambut pubis (11-12tahun), rambut ketiak dan
badan (13-15tahun), kumis,cambang, jenggot (13-15tahun)
f) perkembangan kelenjar keringat ketiak (13–15tahun)
g) suara pecah dan membesar (14-15tahun).
Perkembangan fisik pada anak perempuan maupun laki-laki yang
begitu cepat dan drastis pada usia 11 sampai 16 tahun membutuhkan
waktu beberapa saat untuk dapat beradaptasi dengan keadaan tersebut.

b. Perkembangan Psikososial
Perkembangan psikososial pada remaja menurut Erikson adalah
identitas dan kebingungan peran yang terjadi pada usia 12-20 tahun.
Pembentukan identitas selama masa remaja merupakan tugas utama
dalam perkembangan kepribadian yang diharapkan tercapai pada masa
remaja akhir.Selama masa remaja ini kesadaran akan identitas menjadi
lebih kuat karena itu ia berusaha mencari identitas dan mendefinisikan
kembali “siapakah”ia saat ini dan akan menjadi “siapakah” atau
menjadi “apakah” ia dimasa mendatang.Perkembangan identitas
selama masa remaja ini juga sangat penting karena ia memberikan
suatu landasan bagi perkembangan psikososial dan relasi
interpersonalpada masa dewasa.
Tahap perkembangan identitas (Desmita, 2005 dalam Nastriati,
2011) meliputi:
1) Tahap diferensiasi (12-14 tahun ) karakteristik tahap ini adalah
remaja menyadari bahawa ia berbeda secara psikologis dari orang
tuanya. Kesadaran ini sering membuatnya mempertanyakan dan
menolak nilai- nilai dan nasehat orang tuanya, sekalipun nilai dan
nasehat tersebut masuk akal
2) Tahap praktis (14–15 tahun) arakteristik tahap ini adalah remaja
percaya bahwa ia mengetahui segala-galanya dan dapat
melakukan sesuatu tanpa salah. Ia menyangkal kebutuhan akan
peringatan atau nasehat dan menantang orangtuanya pada setiap
kesempatan. Komitmennya terhadap teman-teman juga bertambah
3) Tahap penyesuaian (15-18 tahun). Karakteristik tahap ini adalah
karena kesedihan dan kekhawatiran yang dialaminya mendorong

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 remaja untuk menerima kembali sebagian otoritas orang tuanya
tetapi dengan syarat. Tingkah lakunya sering silih berganti antara
eksperimentasi dan penyesuaian, kadang mereka menantang dan
kadang berdamai dan bekerjasama dengan orang tua mereka.
Disatu sisi ia menerima tanggung jawab di sekitar rumah namun
disisi lain ia akan mendongkol ketika orang tuanya selalu
mengontrol, membatasi gerak gerik dan aktifitasnya diluar rumah.
4) Tahap konsolidasi (18-21 tahun). Karakteristik pada tahap ini
adalah remaja mengembangkan kesadaran akan identitas personal
yang menjadi dasar pemahaman dirinya dan orang lain serta untuk
mempertahankan otonomi, independen dan invidualitas.
Remaja yang berhasil mencapai suatu identitas diri yang stabil
akan memperoleh suatu pandangan yang jelas tentang dirinya,
memahami perbedaan dan persamaannya dengan orang lain,
menyadari kelebihan dan kekurangan dirinya, penuh percaya diri,
tanggap terhadap berbagai situasi, mampu mengambil keputusan
penting, mampu mengantisipasi tantangan masa depan serta mengenal
perannya dimasyarakat (Desmita, 2005 dala Nastriati, 2011)

1) Perkembangan Psikososial Remaja Awal (10–14Tahun)

(Nastriati, 2011)
a) Cemas Terhadap Penampilan Badan / Fisik
b) Perubahan Hormonal
c) Menyatakan Kebebasan Dan Merasa Sebagai Seorang
Individu, Tidak Hanya Sebagai Anggota Keluarga
d) Perilaku Memberontak Dan Melawan
e) Kawan Menjadi Lebih Penting
f) Perasaan Memiliki Terhadap Teman Sebaya, Anak Laki-Laki
Membentuk Gang, Kelompok, Anak Perempuan Mempunyai
Sahabat
g) Sangat Menuntut Keadilan Tapi Cenderung Melihat Sesuatu
Sebagai Hitam Putih Serta Dari Sisi Pandang Mereka Sendiri.
Dampak terhadap anak diantaranya:
a) Kesadaran Diri Meningkat (Self Consciousness )
b) Menjadi Pemarah, Anak Laki-Laki Yang Tadinya Baik Dapat
Menjadi Agresif
c) Bereksperimen Dengan Cara Berpakaian, Berbicara Dan Cara
Penampilan Diri Sebagai Suatu Usaha Untuk Mendapatkan
Identitas Baru
d) Kasar Dan Menuntut Memperoleh Kebebasan
e) Ingin Tampak Sama Dengan Teman Dalam Cara Berpakaian,
Gaya Rambut, Mendengarkan Music
f) Pengaruh Teman Menjadi Sangat Besar, Remaja Tidak Mau
Berbeda Dengan Dari Teman Sebaya
g) Tampak Tidak Toleransi Dan Sulit Berkompromi, Timbul Iri
Hati Dengan Saudara Kandung.

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2) Perkembangan Psikososial Remaja Pertengahan (15-16 Tahun )
(Nastriati, 2011)
a) Lebih Mampu Berkompromi
b) Belajar Berfikir Secara Independen Dan Membuat Keputusan
Sendiri
c) Terus Menerus Bereksperimen Untuk Mendapatkan Citra
Diri Yang Dirasakan Nyaman Bagi Mereka
d) Merasa Perlu Mengumpulkan Pengalaman Baru, Mengujinya
Walaupun Beresiko
e) Tidak Lagi Terfokus Pada Diri Sendiri
f) Membangun Norma/Nilai Dan Mengembangkan Realitas
g) Membutuhkan Lebih Banyak Teman Dan Rasa Setia Kawan
h) Mulai Membina Hubungan Lawan Jenis
i) Intelektual Lebih Berkembang Dan Ingin Tahu Banyak
Hal,Berfikir Abstrak
j) Berkembangnya Ketrampilan Intelektual Khusus
k) Mengembangkan Minat Yang Besar Terhadap Bidang Seni
Dan Olah Raga
l) Senang Berpetualang,Ingin Bepergian Sendiri.
Dampak terhadap anak diantaranya:
a) Lebih Tenang, Sabar Dan Lebih Toleransi. Dapat Menerima
Pendapat Orang Lain Meskipun Berbeda Dengan
Pendapatnya Sendiri
b) Menolak Campur Tangan Orang Tua
c) Baju, Gaya Rambut, Sikap Dan Pendapat Mereka Sering
Berubah-Ubah
d) Mulai Bereksperiman Dengan Rokok , Alkohol Dan Napza
e) Lebih Bersosialisasi Dan Tidak Lagi Pemalu
f) Mempertanyakan Nilai , Norma Yang Diterima Dari
Keluarga
g) Menghabiskan Waktu Lebih Banyak Dengan Teman, Mulai
Pacaran
h) Mulai Mempertanyakan Sesuatu Yang Sebelumnya Tidak
Berkesan. Ingin Mengikuti Debat Dan Diskusi
i) Mungkin Mengabaikan Pelajaran Sekolah Karena Adanya
Minat Yang Baru.

3) Perkembangan Psikososial Remaja Akhir ( 17-19 Tahun )

(Nastriati, 2011)
a) Ideal
b) Terlibat Dalam Kehidupan, Pekerjaan Dan Hubungan Diluar
Keluarga
c) Harus Belajar Untuk Mencapaikemandirian Baik Dalam
Bidang Finansial Maupun Emosional
d) Lebih Mampu Membuat Hubungan Yang Stabil Dengan
Lawan Jenis
e) Merasa Sebagai Orang Dewasa Yang Setara Dengan Anggota
Keluarga Lainnya
f) Hampir Siap Untuk Menjadi Orang Dewasa Yang Mandiri.

9
 Dampak terhadap anak diantaranya:
a) Cenderung menggeluti masalah sosial politik,nilai – nilai
agama
b) Mulai belajar mengatasi stress yang dihadapinya
c) Kecemasan dan ketidakpastian masa depan dapat merusak
harga diri remaja
d) Mempunyai pasangan yang lebih serius
e) Cenderung merasa pengalamannya berbeda dengan orang tua
4. Tugas perkembangan masa remaja
William Kay, sebagaimana dikutip Jahja (2011) dalam Putro
(2017) mengemukakan tugas-tugas perkembangan masa remaja sebagai
berikut:
a. Menerima fisiknya sendiri berikut keragaman kualitasnya.
b. Mencapai kemandirian emosional dari orangtua atau figur-figur yang
mempunyai otoritas.
c. Mengembangkan ketrampilan komunikasi interpersonal dan bergaul
dengan teman sebaya, baik secara individual maupun kelompok.
d. Menemukan manusia model yang dijadikan identitas pribadinya.
e. Menerima dirinya sendiri dan memiliki kepercayaan terhadap
kemampuannya sendiri.
f. Memeperkuat self-control (kemampuan mengendalikan diri) atas
dasar skala nilai, prinsip-prinsip, atau falsafah hidup
(weltanschauung).
g. Mampu meninggalkan reaksi dan penyesuaian diri (sikap/perilaku)
kekanak-kanakan
Jahja (2011) dalam Putro (2017) mengemukakan pendapat Luella
Cole yang mengklasifikasikannya ke dalam sembilan kategori mengenai
tujuan tugas perkembangan remaja, yaitu:
a. Kematangan emosional.
b. Pemantapan minat-minat heteroseksual.
c. Kematangan sosial.
d. Emansipasi dari control keluarga.
e. Kematangan intelektual.
f. Memilih pekerjaan.
g. Menggunakan waktu senggang secara tepat.
h. Memiliki falsafah hidup.
i. Identifikasi diri.

10
B. Kesehatan Jiwa Pada Remaja
1. Kesehatan jiwa remaja
Pada remaja sering terjadi masalah mental emosional. Masalah
mental emosional dapat timbul jika terdapat sesuatu yang menghambat
seseorang dalam proses penyesuaian diri dengan lingkungan dan
pengalaman-pengalamannya (Dhamayanti, 2011 dalam Nihayati, dkk,
2017).

Gambaran masalah mental emosional seperti gejala depresi,

kecemasan, perilaku menarik diri, kesedihan, perasaan bersalah,
ketakutan dan kekhawatiran berlebih sehingga menghambat kesuksesan
akademik dan hubungan dengan teman sebaya, temperamen sulit,
ketidakmampuan memecahkan masalah, gangguan perhatian,
hiperaktivitas, perilaku bertentangan (tidak suka ditegur/diberi masukan
positif, tidak mau ikut aturan) dan perilaku agresif. Permasalahan yang
terjadi pada remaja juga berbeda. Remaja awal usia 12- 16 tahun
dikatakan sebagai periode yang paling penuh stres dibandingkan dengan
masa remaja pertengahan dan akhir (Krenke, 2009 dalam Nihayati, dkk,
2017).

11
2. Pengaruh lingkungan terhadap perkembangan jiwa remaja (Kusumawati, F,
2010 dalam Nastriati, 2011)
a. Lingkungan keluarga
1) Pola asuh keluarga
Proses sosialisasi sangat dipengaruhi oleh pola asuh dalam
keluarga, berikut adalah jenis dari pola asuh:
a) pola asuh yang otoriter akan menyebabkan remaja berkembang
menjadi penakut, tidak memiliki rasa percaya diri, merasa tidak
berharga, sehingga proses sosialisasi terganggu.
b) Pola asuh permisif akan menumbuhkan sikap ketergantungan
dan sulit menyesuaikan diri
c) pola asuh demokratis akan menimbulkan kesimbangan antara
perkembangan individu dan sosial sehingga anak akan
memperoleh suatu kondisi mental yang sehat.
2) Kondisi keluarga
Hubungan orang tua yang harmonis akan menumbuhkan kehidupan
emosional yang optimal terhadap perkembangan kepribadian anak.
3) Pendidikan moral dalam keluarga
Pendidikan moral dalam kelurga adalah upaya menanamkan nilai-
nilai akhlak atau budi pekerti kepada anak dirumah. Budi pekerti
mengandung nilai-nilai keagamaan, kesusilaan dan kepribadian.
Apabila keluarga tidak perduli terhadap pendidikan moral dalam
keluarga akan berakibat buruk terhadap perkembangan jiwa
remaja.
b. Lingkungan sekolah
Lingkungan sekolah mempunyai pengaruh yang kuat terhadap
perkembangan remaja. Suasana sekolah sangat berpengaruh terhadap
perkembangan jiwa remaja yaitu dalam hal kedisiplinan, kebiasaan
sekolah, pengendalian diri dan bimbingan guru
c. Lingkungan teman sebaya
Remaja lebih banyak berada diluar rumahdengan teman sebaya. Jadi
dapat dimengerti bahwa sikap, pembicaraan, minat, penampilan dan
perilaku teman sebaya lebih besar pengaruhnya daripada keluarga.
Kelompok sebaya memberikan lingkungan yaitu dunia tempat remaja

12
 dapat melakukan sosialisasi dimana nilai yang berlaku bukanlah nilai
yang ditetapkan oleh orang dewasa melainkan oleh teman seusianya.
Disinilah letak bahayanya bagi perkembangan jiwa remaja
d. Lingkungan masyarakat
Lingkungan masyarakat yang berpengaruh terhadap perkembangan
jiwa remaja adalah sosial budaya dan media massa. Pergeseran budaya
lokal dan budaya nasional akan tertembus oleh budaya universal
sehingga terjadi pergeseran nilai kehidupan. Pergeseran nilai ini akan
menyebabkan konflik nilai yang dapat berakibat terjadinya
penyimpangan perilaku pada remaja.
3. Masalah Kesehatan Jiwa Remaja
a. Gangguan cemas / ansietas
Cemas (ansietas)adalah perasaan gelisah yang dihubungkan dengan
antisipasi terhadap bahaya. Gangguan cemas merupakan gangguan
yang banyak terjadi pada anak dan remaja. Prevalensi gangguan
cemas ini adalah 5 – 50 %.Fobia sosial ditemukan lebih banyak pada
anak laki-laki sedangkan fobia simpel, gangguan menghindar lebih
banyak pada anak perempuan.

b. Gangguan mood
Depresi pada anak- anak dan remaja berkisar antara 1 – 5 %. Seorang
remaja mempunyai kecenderungan untuk mengalami depresi. Oleh
karena itu sangat penting untuk membedakan secara jelas dan hati– hati
antara depresi yang disebabkan oleh gejolak mood yang normal pada
remaja dengan depresi patologik. Depresi pada remaja sering tidak
terdiagnosis. Adanya gangguan mood akan beresiko terjadinya perilaku
bunuh diri pada remaja. Bunuh diri adalah penyebab kematian utama
ketiga pada individu berusia 15–24 tahun. Tanda–tanda bahaya bunuh
diri pada remaja meliputi menarik diri secara tiba-tiba, berperilaku
keras atau sangat memberontak, menyalahgunakan obat atau alkohol,
secara tidak biasa mengabaikan penampilan diri, kualitas tugas sekolah
menurun, membolos, keletihan berlebihan dan keluhan somatik, respon
yang buruk terhadap pujian, ancaman bunuh diri terang-terangan
secara verbal dan membuang benda-benda yang didapat sebagai hadiah

13
 c. Gangguan Psikotik
Gangguan psikotik adalah suatu kondisi terdapatnya gangguan yang
berat dalam kemampuan menilair realitas.Yang termasuk gangguan
psikotik adalah skizoprenia. Skizoprenia pada remaja merupakan hal
yang umum dan insidennya selama remaja akhir sangat tinggi. Gejala
awalnya meliputi perubahan ekstrem dalam perilaku sehari- hari,
isolasi sosial, sikap yang anah,penurunan nilai akademik dan
mengekspresikan peilaku yang tidak disadarinya (Kusumawati, F,
2010 dalam Nastriati, 2011).
d. Gangguan Penyalahgunaan Zat
Gangguan ini banyak terjadi diperkirakan 32 % remaja menderita
gangguan penyalahgunaan zat (Kusumawati, F, 2010). Angka
penggunaan alkohol atau zat terlarang lebih banyak pada anak laki-laki
dibanding perempuan. Resiko terbesar pada usia 15 – 24 tahun. Pada
remaja perubahan penggunaan zat menjadi ketergantungan zat terjadi
lebih cepat dalam kurun waktu 2 tahun. Identifikasi remaja
penyalahguna NAPZA terdapat pada konflik keluarga yang berat,
kesulitan akademik, penyalahgunaan NAPZA oleh orang tua dan
teman, merokok pada usia muda.
4. Penatalaksanaan Gangguan Jiwa Remaja
Penatalaksanaan gangguan jiwa remaja diantaranya:
a. Pencegahan primer melalui berbagai program sosial yang ditujukan
untuk menciptakan lingkungan yangmeningkatkan kesehatan anak;
b. Pencegahan sekunder dengan menemukan kasus secara dini pada
remaja yang mengalami kesulitan di sekolah sehingga tindakan yang
tepat dapat segera dilakukan;
c. Dukungan terapeutik bagi anak-anak diberikan melalui psikoterapi
individu, konseling remaja dan program pendidikan khusus untuk
remaja yang tidak mampu berpartisipasi dalam sistem sekolah normal;
d. Terapi keluarga dan penyuluhan keluarga penting untuk membantu
keluarga mendapatkan ketrampilan dan bantuan yang diperlukan guna
membuat perubahan yang dapat meningkatkan fungsi semua anggota
keluarga (Kusumawati, F, 2010 dalam Nastriati, 2011).
14
 BAB III
KONSEP ASUHAN KEPERAWATAN JIWA PADA REMAJA

A. Pengkajian

Karakteristik Perilaku

Tugas perkembangan Perilaku remaja

Perkembang an yang a. Menilai diri secara objektif

normal: Identitas diri b. Merenanakan masa depannya
c. Dapat mengambil keputusan
d. Menyukai dirinya
e. Berinteraksi terhadap lingkungannya
f. Bertanggung jawab
g. Mulai meperlihatkan kemandirian di
keluarga
h. Menyelasaikan masalah dengan
meminta bantuan orang yang
menurutnya mampu
Penyimpang an perkem a. Tidak menemukan ciri khas
bangan bingung peran (kekuatan dan kelemahan) dirinya
b. Merasa bingung, bimbang
c. Tidak mempunyai rencana untuk
masa depan
d. Tidak mampu berinteraksi dengan
lingkungannya
e. Memiliki perilaku antisosisal
f. Tidak menyukai dirinya
g. Sulit mengambil keputusan
h. Tidak mempunyai minat
i. Tidak mandiri
B. Diagnosa Keperawatan

Potensial Kesiapan peningkatan perkembangan remaja :

(Normal) pembentukan identitas diri
Risiko Resiko tidak efektifnya pemgambilan Peran

15
C. Intervensi
1) Remaja
Tujuan
a) Remaja dapat menyebutkan karakteristik perkembangan
psikososial yang normal dan menyimpang
b) Remaja dapat menjelaskan cara mencapai perkembangan psikososial
yang normal
c) Remaja melakukan tindakan untik mencapai perkembangan
psikososial yang normal

Tugas Intervensi
perkembangan keperawat
an
Perekembangan yang a. Diskusikan dengan remaja ciri
normal Pembentuk perkembangan psikososial remaja yang
identitas diri normal dan menyimpang
b. Diskusikan cara-cara untuk mencapai
perkembangan psikososial yang normal:
c. Anjurkan remaja berinteraksi dengan orang
lain yang membuat remaja nyaman untuk
mencurahkan perasaan, perhatian dan
kekhawatiran
d. Anjurkan remaja mengikuti organisasi yang
mempunyai kegiatan positif (OR, seni,
beladiri, pramuka, pengajian)
e. Anjurkan remaja melakukan kegiatan
dirumah, sesuai dengan perannya
f. Bimbing dan motivasi remaja membuat
rencana kegiatan
dan melaksanaan rencana yang telah dibuatnya
Penyimpangan a. Diskusi aspek positif/kelebihan yang dimiliki
perkembangan remaja
Bingung peran b. Bantu mengidentifikasi berbagai
peran yang dapat ditampilkan remaja
dalam kehidupannya
c. Diskusikan penampilan peran yang terbaik
untuk remaja
d. Bantu remaja mengidentifikasi perannya
dikeluarga

2) Keluarga
Tujuan
a) Memahami perilaku yang menggambarkan perkembangan remaja yang
normal dan menyimpang
b) Memahami cara mestimulasi perkembangan remaja
16
 c) Mendemonstrasikan tindakan untuk stimulasi perkembangan remaja
d) Merencanakan tindakan untuk mengembangkan kemampuan
psikososial remaja

Intervensi keperawatan

a) Menjelaskan tentang ciri perkembangan remaja yang normal dan

menyimpang
b) Menjelaskan cara yang dapat dilakukan keluarga untuk
memfasilitasi perkembangan remaja yang normal
c) Fasilitas remaja untuk berinteraksi dalam kelompok sebaya
d) Anjurkan remaja bergaul dengan orang lain yang membuat remaja
nyaman mencurahkan perasaan, perhatian, dan kekhawatirannya
e) Anjurkan remaja mengikuti organisasi yang mempunyai kegiatan positif
(OR, seni, beladiri, pramuka, pengajian)
f) Berperan sebagai teman curhat bagi remaja
g) Berperan sebagai contoh peran baik bagi remaja dalam melakukan
interaksi sosial yang baik
h) Berikan lingkungan yang nyaman bagi remaja untuk melakukan aktivitas
bersama kelompoknya
i) Diskusikan dan mendemonstrasikan tindakan untuk membantu
remaja memperoleh identitas diri
j) Diskusi rencana tindakan yang akan dilakukan oleh keluarga
untuk memfasilitasi remaja memperoleh identifikasi diri

D. Implementasi
Implementasi yang diberikan adalah dalam bentuk pendidikan kesehatan
kepada remaja dan keluarga tentang perkembangan psikososial yang normal
dan menyimpang pada remaja.

E. Evaluasi
Evaluasi dilakukan untuk melihat bagaimana perkembangan yang
dilakukan oleh perawat. Adapun hasil evaluasi yang diharapkan adalah
peningkatan perkembangan pada remaja, baik dalam aspek fisik, kognitif,
psikososial, dan moral.

17
 BAB IV
PENUTUP

A. Kesimpulan
Pada remaja sering terjadi masalah mental emosional. Masalah mental
emosional dapat timbul jika terdapat sesuatu yang menghambat seseorang
dalam proses penyesuaian diri dengan lingkungan dan pengalaman-
pengalamannya. Dalam rentang kesehatan jiwa remaja dibutuhkan dukungan
dari berbagai pihak termasuk salah satunya keluarga untuk menangani
manajemen stress pada remaja. Sikap remaja juga harus positif dalam
menanggapinya.

B. Saran
Dengan adanya pedoman penatalaksanaan kesehatan jiwa pada remaja
diharapkan dapat digunakan untuk membantu pertumbuhan dan perkembangan
kesehatan jiwa remaja. Dan untuk remaja diharapkan dapat mengetahui tentang
kesehatan jjiwa remaja dan dapat mengarahkan sikapnya ke hal yang positif.
Sedangkan untuk orang tua dan lingkungan haruslah saling melengkapi untuk
mewujudkan remaja yang sehat jiwa.

18
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 Kasetsart Journal of Social Sciences xxx (2018) 1e5

Contents lists available at ScienceDirect

Kasetsart Journal of Social Sciences

journal homepage: http://www.elsevier.com/locate/kjss

Exploring the effectiveness of cognitive behavioral therapy for

Vietnamese adolescents with anger problems
Huyen Thi Bui a, *, Lynn Mackie b, Phuoc Anh Hoang a, Thu Thi Tran a
a
Department of Psychology and Education, Hanoi National University of Education, 136 Xuan Thuy, Cau Giay, Hanoi, Vietnam
b
Bolton Educational Psychology Services, United Kingdom

article info ABSTRACT

Article history: The evidence base for cognitive behavioral therapy (CBT) is promising for the treatment of
Received 23 October 2017 anger in both adults and children in most European and Western countries. The goal of the
Received in revised form 17 January 2018 current study was to explore the effectiveness of this therapeutic approach for anger
Accepted 9 May 2018
problems in Vietnam as a non-Western culture and non-English speaking country. A
Available online xxxx
randomized controlled trial was undertaken with 40 adolescents for three months, using
different CBT techniques. A medium effect size of .64 (Cohen's d) was found for a CBT
Keywords:
intervention. Anger management skills of older adolescents (aged from 14 to 16) improved
anger problems,
more than those of younger adolescents (aged from 12 to 13). The findings of the current
cognitive behavioral therapy,
study replicated previous studies regarding the high cost-effectiveness of CBT intervention
Vietnamese adolescents
for anger problems in children and adolescents. Furthermore, the suitability of the group
CBT format for the treatment of anger within this study was consistent with other studies
as well. This adds valuable evidence to the paucity of CBT literature on culturally
responsive CBT in diverse populations. Despite this, more research is needed to produce
evidence-based CBT for other Asian countries as well as other populations.
© 2018 Kasetsart University. Publishing services by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/
4.0/).

Introduction 2007; Down, Willer, Watts, & Griffiths, 2011), and it is

In the literature, research has found that anger has
received less attention than other emotions, such as anxi-
ety or depression (DiGiuseppe & Tafrate, 2010). Although
anger is one of the basic human emotions (Stringaris, 2015),
it is widely viewed as a negative emotional state
(Berkowitz, 1993; Nelson & Schultz, 2009). When anger is
excessive in frequency and duration (Kennerley,
Westbrook, & Kirk, 2016) or left untreated, it can lead to
various emotional and behavioral problems, particularly for
children and adolescents (Alavinezhad, Mousavi, & Sohrabi,
2014). The experience of anger has been believed to be a
common occurrence in adolescence (Blake & Hamrin,
* Corresponding author.
E-mail address: thesmalldaughter@gmail.com (H.T. Bui).
Peer review under responsibility of Kasetsart University.
also a common foundation of three of the main causes of
death in adolescents, injuries, homicide, and suicide
(Puskar, Ren, & McFadden, 2015). There is, fortunately, ev-
idence that cognitive-behavioral therapy (CBT) can be an
effective treatment for anger problems (Kennerley et al.,
2016). To date, 10 meta-analytic reviews of the effect of
psychology for anger treatment have been published (Beck
& Fernandez, 1998; Del Vecchio & O’Leary, 2004;
DiGiuseppe & Tafrate, 2003; Edmondson & Conger, 1996;
Gansle, 2005; Henwood, Chou, & Browne, 2015; Ho,
Carter, & Stephenson, 2010; Saini, 2009; Sukhodolsky,
Kassinove, & Gorman, 2004; Tafrate, 1995). The treatment
outcomes of these meta-analyses suggest that cognitive
behavioral therapy is effective and produces a moderate
effect size. For example, a medium effect size (Cohen's
d ¼ .67) was found in Sukhodolsky et al.’s (2004) study for
CBT in the treatment of anger for children and adolescents.

https://doi.org/10.1016/j.kjss.2018.05.013
2452-3151/© 2018 Kasetsart University. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article in press as: Bui, H. T., et al., Exploring the effectiveness of cognitive behavioral therapy for Vietnamese
adolescents with anger problems, Kasetsart Journal of Social Sciences (2018), https://doi.org/10.1016/j.kjss.2018.05.013
2 H.T. Bui et al. / Kasetsart Journal of Social Sciences xxx (2018) 1e5
Similarly, CBT was moderately effective for anger-related
behaviors in children with special education needs (Ho
et al., 2010).
Among different psychological therapies, CBT is not
viewed as a singular approach, but as comprising or
merging with other approaches (for example, cognitive and
behavioral approaches) with the aim of helping clients to
achieve appropriate cognition, emotion, and behavior
(Curran, Machin, & Gournay, 2006). Kendall, Peterman, and
Cummings (2015, p. 496) argued that CBT “represents an
integration of both cognitive and behavioral models of psy-
chopathology”. The basic as well as the traditional CBT
model sees that psychological distress consists of three key
elements: feelings, cognitions, and behaviors. All these el-
ements are interrelated so a change in one element can lead
to a change in either of the others. For example, Simmons
and Griffiths (2014) propose a model of CBT supposing
that situations themselves do not cause the physiological
problems, but rather it is the way people interpret, make
sense of, and react to situations. People will experience
distress if they interpret an event negatively. Intervention
based on the CBT model aims to correct negative bias in
thinking processes and behavioral reactions. In other
words, cognitive behavioral interventions break the vicious
cycle of the problems by creating positive change in one or
more elements of the psychological distress with the use of
various techniques and strategies. Nevertheless, the vast
majority of CBT studies have been undertaken with Western
samples (Hays & Iwamasa, 2014; Naeem, Gobbi, Ayub, &
Kingdon, 2010) regarding anger-related problems. Also,
few programmes have been implemented with school-age
children (Blake & Hamrin, 2007). The evidence to support
the effectiveness of CBT for non-Western norms is, unfor-
tunately, limited. While there is a current need for culturally
responsive CBT (Hays & Iwamasa, 2014), would CBT as “the
most widely researched evidence-based psychotherapy”
(Hays, 2009, p. 354) be effective for treating anger problems
in Vietnamese adolescents? The current study aimed to
explore the effectiveness of CBT in a particular context in
order to answer the above question.
Method
Participants
Based on results from a screening study with 395 ado-
lescents, 40 students were identified as having moderate and
high anger problems and so were chosen for the study. The
Children's Inventory of Anger (the CHIA-Nelson & Finch,
2000) was employed here as a screening measure, and
these 40 chosen students were selected according to certain
criteria. As such, they all had anger T scores ranging from 60 to
70 which were then viewed as being clinically significant
indicators of anger according to the CHIA's manual. These 40
adolescents were then randomly allocated to either the study
group for three months or to the comparison group.
Setting
The CBT intervention was undertaken in the school
environment (a private school in Hanoi) which offers
school psychology services to students.
Please cite this article in press as: Bui, H. T., et al., Exploring the effectiveness of cognitive behavioral therapy for Vietnamese
adolescents with anger problems, Kasetsart Journal of Social Sciences (2018), https://doi.org/10.1016/j.kjss.2018.05.013
Measures
The Children's Inventory of Anger (the CHIA-Nelson &
Finch, 2000), which had already been tested with high
reliability and validity in a Vietnamese sample, was employed
as the main assessment tool for adolescents and was used
pre-treatment and post-treatment. According to Nelson and
Finch (2000), the CHIA has an excellent internal consistency
with a Cronbach alpha coefficient reported of .95. In the
current study, the Cronbach alpha coefficient for the CHIA
was .91. Once students were identified as having anger
problems through the CHIA (pre-treatment), the interven-
tion was then conducted for three months and the post-
treatment measurement was undertaken after the
intervention.
Procedures
The procedures followed were in accordance with the
ethical standards of the University of Bolton (University
Code of Practice on Ethical Standards for Research Involving
Human Participants) and were approved by the Board of
Studies for Research Degrees. Before the intervention, all
participants were asked to sign an informed consent form
to indicate that they were aware of being involved in the
intervention and agreed to join, along with the agreement
of their parents or caregivers.
The CBT intervention was carried out in a group format
with 20 adolescents aged from 12 to 16 years for 12 weeks
in 2015. Assessments were undertaken pre-treatment and
post-treatment for both the control and the intervention
groups. The CBT intervention included psycho-education
about anger, the benefits and costs of becoming angry,
the basic principles of CBT, and practicing anger manage-
ment skills such as self-talk, problem solving, assertion, and
relaxation.
Design
A randomized controlled trial (RCT) was conducted on
adolescents who had been identified as having anger
problems through the Children's Inventory of Anger. In
total, 40 students experiencing moderate and high anger
problems were allocated to either the intervention (N ¼ 20)
or the control conditions (N ¼ 20). While children in the
intervention were offered a CBT intervention for three
months, those in the control condition did not receive any
treatment. After three months, these 40 students again
completed the CHIA to evaluate their improvement in
terms of anger management skills.
Results
At the end of the 12- week study, no dropouts were
reported. A paired-samples t-test was performed to explore
the impact of the CBT intervention with Vietnamese ado-
lescents who were identified with moderate and high
anger problems. The results revealed that there was a sta-
tistically significant decrease in anger score from time 1
(pre-treatment) (M ¼ 114.08, SD ¼ 8.35) to time 2 (post-
treatment) (M ¼ 108.60, SD ¼ 8.61), t (39) ¼ 5.22, p < .001
 H.T. Bui et al. / Kasetsart Journal of Social Sciences xxx (2018) 1e5
Table 1
Anger score for intervention and the control groups across two time periods
Condition Pre-intervention
N M SD
Control 20 112.80 6.93
Intervention 20 115.40 9.57
Table 2
Mean and SD of younger and older adolescents over two time periods
Age group Pre-intervention
N M
Older adolescents 10 110.80
Younger adolescents 10 120.00
Total 20 115.40
(two-tailed). The comparison between the control and the
intervention group showed there was also a difference in
anger scores between the two intervals (Table 1). A me-
dium effect size (Cohen's d ¼ .64) was found for CBT in
treating anger problems in Vietnamese adolescents.
A two-way 2  2 (Age [younger adolescents, older
adolescents]  Time [time 1, time 2]) mixed between-
within subjects analysis of variance (ANOVA) was con-
ducted to find out if anger scores differed with age. The
results illustrated that there were no statistically significant
differences in anger scores for age at time 1, but a difference
was found for age at time 2 (Table 2). The ANOVA result
indicates that older adolescents (aged 14e16 years) had a
greater reduction in anger score than younger adolescents
(aged 12e13 years), F (1, 18) ¼ 8.70, p ¼ .009, partial eta
squared ¼ .32.
Discussion and Implications
The findings from this RCT were broadly consistent with
previous studies regarding the effectiveness of CBT for
anger problems in children. A medium effect size (Cohen's
d ¼ .64) was similar to previous studies about the effec-
tiveness of CBT for children with anger problems. As
cognitive behavioral techniques are the most widely used
and empirically validated for anger and aggression in young
people (Blake & Hamrin, 2007), these CBT techniques were
also found to be useful and had promising impact for ad-
olescents suffering anger problems in this study. In
particular, skills training was more effective in reducing
anger experiences. The outcome of the current study
interestingly replicates studies of Western samples. We
commonly see the differences between Western and non-
Western countries in terms of cultures, beliefs, values,
and rationality (Gonza lez-Prendes, 2013; Kelly, 2014;
Naeem, 2011). Nevertheless, we found CBT had moderate
effectiveness for Vietnamese adolescents as in other
studies in Western children. This is valuable because it adds
more to the literature of the acceptability and the efficacy of
CBT for Asian populations with anger problems, which is
still limited.
The suitability of group CBT for anger problems in
children was clarified within this study. This randomized
Please cite this article in press as: Bui, H. T., et al., Exploring the effectiveness of cognitive behavioral therapy for Vietnamese
adolescents with anger problems, Kasetsart Journal of Social Sciences (2018), https://doi.org/10.1016/j.kjss.2018.05.013
3
Post-intervention t p
N M SD
20 119.90 7.04 5.22 <.001
20 105.30 8.93
Post-intervention F p
SD N M SD
8.45 10 100.20 8.02
8.65 10 110.40 6.81
9.57 20 105.30 8.93 8.70 .009
controlled trial also verifies the conclusion of Siddle, Jones,
and Awenat (2003) as well as of Down, Willner, Watts, and
Griffiths (2011) that “group anger management interventions
appear to be more cost-effective” (Down et al., 2011, p. 34).
Within the current RCT, older adolescents (aged 14e16
years) reduced anger scores more than younger adoles-
cents (aged 12e13 years). This is also congruent with other
studies suggesting that older adolescents benefit more
from group CBT than younger adolescents (Durlak,
Fuhrman, & Lampman, 1991; Sukhodolsky et al., 2004),
and adolescents aged 14 years and above benefitted the
most from CBT groups (Down et al., 2011). With regard to
the increase in anger scores in the control group (Table 1), it
is worth noting that not only did the intervention lead to a
decrease in anger scores in the intervention group but this
occurred, when, under the general conditions in schools,
the control group evidenced increasing anger. This proves
that intervention, particularly CBT interventions, for chil-
dren with anger problems in school is vital and needs to be
done regularly. Within this study, no dropouts were re-
ported. This is consistent with Graham's (2005) conclusion
that the dropout rate of clinical trials with children and
adolescents has been relatively low (less than 15%)
compared with that of adult therapy using CBT (reported at
26.2%; Fernandez, Salem, Swift, & Ramtahal, 2015).
Finally, the current study with non-Western samples
indicates that self-report inventories are effective and
suitable for identifying anger problems, and these anger
assessments which were developed in the West can be
applied effectively to Asian populations. Within this study,
the CHIA helped to not only identify students with anger
problems but also to evaluate the effectiveness of the CBT
intervention. Most researchers have highlighted the suit-
ability and the availability of self-report measures for
measuring people’ beliefs and feelings (for example, Field &
Hole, 2003; Haslam & McGarty, 2014; Nelson & Finch,
2000) and the current study replicated that conclusion.
This study also provided an explanation for the suitability
of self-report inventories for anger to the extent that the
CHIA assesses the experience of anger of children but not
the expression of anger. In the literature, the emotion of
anger is considered as one of the five basic human emo-
tions along with happiness, fear, joy, and sadness
4 H.T. Bui et al. / Kasetsart Journal of Social Sciences xxx (2018) 1e5
(Stringaris, 2015). Additionally, it has been commonly
accepted that anger is a universal and a natural emotion,
experienced more similarly around the world than differ-
ently (Tanaka-Matsimu, 1995).
Despite this, a criticism of the study may lie in the fact
that no follow-up was included, which prevented the study
from investigating the improvement of children over time
or the maintenance of gains. It is concluded that although
effective, the application of CBT in the current study was
only the first attempt in Vietnamese culture to implement
and evaluate a CBT-based intervention for anger problems.
Therefore, more research is needed to confirm that “CBT is
the psychotherapeutic model of choice across cultures if
adapted appropriately” (Rathod & Kingdon, 2009, p. 370).
In terms of implications, the current study emphasizes
the effectiveness of CBT intervention for anger problems
(particularly with older adolescents), the value of a control
group (which in this case seems to clearly indicate that
without intervention the anger problems deteriorated
rather than ameliorated), further emphasizing the impor-
tance of a timely intervention and the value of self-report
inventories. Other recommendations for future studies
would be to examine the effectiveness of CBT for child of-
fenders or with clinical populations in other Asian coun-
tries, because participants in the current study were drawn
from a non-clinical population and were not offenders or
from clinical populations.
Conflict of Interest
The authors have no conflict of interest.
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Please cite this article in press as: Bui, H. T., et al., Exploring the effectiveness of cognitive behavioral therapy for Vietnamese
adolescents with anger problems, Kasetsart Journal of Social Sciences (2018), https://doi.org/10.1016/j.kjss.2018.05.013
Effects of Internet-Based Guided Self-Help Problem-
Solving Therapy for Adolescents with Depression and
Anxiety: A Randomized Controlled Trial
Willemijn Hoek1,2,3*, Josien Schuurmans1, Hans M. Koot2,3, Pim Cuijpers1
1 Department of Clinical Psychology, VU University, Amsterdam, The Netherlands, 2 Developmental Psychology, VU University, Amsterdam, The Netherlands, 3 EMGO+
Institute, Amsterdam, The Netherlands

Abstract
Background: Symptoms of depression and anxiety are highly prevalent in adolescence and they are the cause of
considerable suffering. Even so, adolescents are not inclined to seek professional help for emotional problems. Internet-
based preventive interventions have been suggested as a feasible method of providing appropriate care to adolescents
with internalizing symptoms. The objective of this study was to evaluate the effects of preventive Internet-based (guided)
self-help problem-solving therapy (PST) for adolescents reporting mild to moderate symptoms of depression and/or anxiety
as compared to a waiting list control group (WL).

Methodology/Principal Findings: A total of 45 participants were randomized to the 2 conditions. PST consisted of 5 weekly
lessons. Participants were supported by e-mail. Self-report measures of depression and anxiety were filled in at baseline and
after 3 weeks, 5 weeks, and 4 months. Of the 45 participants, 28 (62.2%) completed questionnaires after 3 weeks, 28 (62.2%)
after 5 weeks, and 27 (60%) after 4 months. Hierarchical linear modeling analyses revealed overall improvement over time
for both groups on depressive and anxiety symptoms. However, no significant group x time interactions were found. No
differences were found between completers and non-completers.

Conclusions/Significance: Results show that depressive and anxiety symptoms declined in both groups. No support was
found, however, for the assumption that Internet-based PST was efficacious in reducing depression and anxiety in
comparison to the waiting list control group. This finding could represent lack of power.

Trial Registration: Netherlands Trial Register NTR1322

Citation: Hoek W, Schuurmans J, Koot HM, Cuijpers P (2012) Effects of Internet-Based Guided Self-Help Problem-Solving Therapy for Adolescents with Depression
and Anxiety: A Randomized Controlled Trial. PLoS ONE 7(8): e43485. doi:10.1371/journal.pone.0043485
Editor: James G. Scott, The University of Queensland, Australia
Received March 26, 2012; Accepted July 20, 2012; Published August 31, 2012
Copyright: ß 2012 Hoek et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This study is funded by ZonMw – the Netherlands organisation for Health Research and Development, grant number 120610006. The funders had no
role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: n.w.hoek@vu.nl

Introduction anxiety in an adolescent school-based population, and a six session

Despite the high prevalence and impact of depression and
anxiety in adolescence [1,2], many young people do not seek
professional help for emotional problems [3]. Internet-based
interventions, however, may enable treatment consideration and
participation. Adolescents are particularly comfortable interacting
within the computer environment [4], and Internet-based
interventions may reduce stigma, maximize autonomy, save
travelling time, provide low cost access, reduce waiting-lists,
abolish the need to schedule appointments with a therapist, and
reduce objections like lack of willingness to talk to a stranger about
personal problems [5,6].
Studies on adolescent Internet-based interventions for depres-
sion or anxiety are scarce (see [4,7,8]) and the effectiveness of
merely two programs was examined in randomized controlled
trials (RCTs) [9,10,11]. These concern a five session cognitive
behavior therapy (CBT) based intervention program (MoodGYM)
in preventing and reducing the symptoms of depression and
guided CBT group course (Master Your Mood) for adolescents
aged 16 to 25 years with depressive symptoms. Previous controlled
pilot trials of the MoodGYM intervention in two private single-sex
schools demonstrated benefits on self-reported depression for
adolescent boys who completed more modules [9] and for girls at
follow-up [10]. A previous study with a more diverse sample
reported decreases in anxiety symptoms for the total sample and
decreases in depression for males only [7]. The online group
course Master Your Mood was effective in reducing depressive
and anxiety symptoms and in increasing mastery in young people
[11].
As far as we know, there is no study which evaluates Internet-
based problem-solving therapy (PST) for adolescents. PST is
aimed at determining the major goals in life, investing energy only
in those problems that are related to what matters and learning to
accept those situations that cannot be changed, with problem-
solving skills as the core element of this approach [12,13]. Face-to-
face problem-solving therapy has been found to be effective in a

PLOS ONE | www.plosone.org 1 August 2012 | Volume 7 | Issue 8 | e43485


variety of problem areas [12,14], and given high comorbidity and
shared risk factors of depression and anxiety [15], the provision of
an intervention that can concurrently decrease depressive and
anxiety symptoms in adolescents would be appealing. A PST-
based intervention that could be applied through the Internet was
developed and studied in an adult population [13]. The
intervention was successful in reducing adults’ symptoms of
depression, anxiety, and work related stress, and was consequently
adapted for adolescents. The aim of the current study is to
evaluate the effects of preventive Internet-based PST for
adolescents reporting mild to moderate symptoms of depression
and/or anxiety as compared to a waiting list control group.
Methods
The protocol for this trial and supporting CONSORT checklist
are available as supporting information; see Checklist S1 and
Protocol S1.
Participants
Participants were recruited through press releases, banners and
advertisements on the Internet, advertisements in magazines,
referral by school-doctors, through brochures and posters in
schools, and through information to parents who are treated in
mental health care institutions for depression and anxiety.
Recruitment took place from January 2009 to May 2011. After
application through a website, applicants received a brochure
about this study and an informed consent form by email. If
adolescents were younger than 18 years of age, parents received a
brochure and an informed consent form by regular mail after
application by the adolescent. Adolescents aged 17 years or
younger needed parental consent for study participation. After
receiving informed consent, adolescents received the baseline
questionnaire by email.
To be included, applicants had to report mild to moderate
depressive and/or anxiety symptoms (there was no lower limit for
entering the study) and have sufficient knowledge of the Dutch
language, access to the Internet, and an email address. At first,
adolescents aged 12 to 18 years with depressive and/or anxiety
symptoms were found eligible for this study. It was difficult to
include adolescents in the study. Inasmuch as we had strong
indications that parental consent requirements often withheld
adolescents from participating [16] and because older adolescents
showed interest in our intervention, the upper age limit was altered
during the study and adolescents aged 19 to 21 years were also
included from April 2010. Adolescents were excluded from the
study if they were younger than 18 years of age and had no
parental permission, were receiving other psychological treatment
for mental health problems, had severe depressive symptoms
(defined as a score above 40 on the Centre for Epidemiologic
Studies Depression scale; CES-D [17]), had severe anxiety
symptoms (indicated by a score above 14 on the anxiety subscale
of the Hospital Anxiety and Depression Scale; HADS-A [18]),
and/or had prominent suicide ideation (indicated by a score above
1 on the suicide item of the Beck Depression Inventory-II; BDI-II
[19]). Respondents who were excluded due to the presence of
severe symptoms received a telephone call in which they were
advised to consult their general practitioner. If younger than 18
years, their parents were also informed by telephone. The study
was approved by the Medical Ethics Committee of the VU
University Medical Center, Amsterdam, the Netherlands. For a
detailed description of the study and intervention we refer to the
study protocol [20].
PLOS ONE | www.plosone.org
Internet-Based PST for Depression and Anxiety
Intervention
The PST intervention was web-based and participants were
provided with a username and password to access the website.
Every week an automated email was sent to participants to explain
the contents and exercises for the coming week. Mental health
care professionals and the authors (WH, JS) offered feedback on
the completed exercises. This feedback was not therapeutic but
was directed at mastering the proposed problem-solving strategies.
PST consisted of three steps. First, respondents described what
really mattered to them. Second, they wrote down their current
worries and problems, and they divided these problems into three
categories: (a) unimportant problems, (b) solvable problems, (c)
problems which cannot be solved. For each of these three types of
problems a different strategy was proposed to solve the problems
or to learn to cope with the unimportant and unsolvable ones. This
step is the most important element of PST. For the solvable
problems, we proposed the following six-step procedure: (1) write a
clear definition of the problem, (2) generate multiple solutions to
the problem, (3) select the best solution, (4) work out a systematic
plan for this solution, (5) carry out the solution, and (6) evaluate as
to whether the solution has resolved the problem. During the third
and last step, the respondents made a plan for the future in which
they described how they would try to accomplish those things that
matter most to them. The course took 5 weeks and consisted of
one lesson a week.
Design
This study is a randomized controlled trial with two groups: an
Internet-based guided self-help intervention (PST) and a waiting
list control group (WL). The study was designed to compare the
effects of the intervention with the waiting list. Based on a power of
0.80 and an alpha of 0.05, we needed 63 patients in each condition
in order to be able to demonstrate moderate effects of d = 0.40.
Therefore, the total sample size was set at 126. 45 participants
were included in total (see Fig. 1). Participants on the waiting list
got access to a website with general information on depression and
anxiety, and could complete the intervention 4 months after
baseline. Questionnaires were administered on the Internet and
were sent after application (baseline) and 3 weeks, 5 weeks, and 4
months later.
Randomization
Randomization took place at an individual level after the
baseline measurement. We used block randomization, with each
block containing 10, 12, 14, or 16 allocations. An independent
researcher made the allocation schedule with a computerized
random number generator. Immediately after randomization,
adolescents were informed about the randomization outcome by
email. If younger than 18 years of age, the subject’s parents also
received this email. We randomized 22 participants to the PST
intervention and 23 participants to the waiting list condition.
Measures
Structured diagnostic interview. Depression and anxiety
subscales of the National Institute of Mental Health Diagnostic
Interview Schedule for Children Version IV (NIMH DISC-IV)
were conducted by telephone before randomization. The Diag-
nostic Interview Schedule for Children is a reliable and valid
structured diagnostic interview designed for lay interviewers,
which includes algorithms to diagnose DSM-IV disorders in
children and adolescents [21]. Participants completed a telephone
version of the generalized anxiety disorder, social phobia, panic,
agoraphobia, major depression, and dysthymia modules of the
2 August 2012 | Volume 7 | Issue 8 | e43485

Figure 1. Progress of participants through the trial.
doi:10.1371/journal.pone.0043485.g001
NIMH DISC-IV. The NIMH DISC-IV assesses the presence of
diagnoses occurring within both the past 12 months and the past 4
weeks. The interview was not a requisite of the study, 33
participants decided to participate. Telephone versions of struc-
tured psychiatric interviews in both adults [22] and youth [23]
have been found to have a high correlation with in-person
interviews.
Depressive symptoms. Depressive symptoms were assessed
with the Centre for Epidemiologic Studies Depression scale (CES-
D) [17]. The CES-D consists of 20 items for which subjects rate
the frequency of symptoms during the past week with scores
ranging from 0 (rarely or none of the time present [less than 1
day]) to 3 (most or all of the time present [5–7 days]), with a total
score ranging between 0 and 60. A cut-off score of $16 can be
used to identify adolescents with mild or greater levels of
depression. The validity of the CES-D has been tested in different
populations, including studies with adolescents [24–26]. In the
current study, Cronbach’s alpha ranged from 0.89 to 0.93.
Anxiety symptoms. To measure the prevalence of anxiety
symptoms, the anxiety subscale of the Hospital Anxiety and
Depression Scale (HADS-A) [18] was used. The HADS-A consists
of seven items rated on a 4-point scale ranging from 0 (not at all) to
3 (a great deal of the time), with 3 indicating higher symptom
frequency. A total score ranges from 0 to 21 and score ranges are
classified as normal (0–7), mild (8–10), moderate (11–14) and
severe (15–21). The HADS shows good homogeneity and
reliability, with Cronbach’s alpha ranging from 0.81 to 0.84 in
different normal and clinical Dutch samples [27], and has been
found valid and adequate for use with adolescents [28].
Cronbach’s alpha in this study varied from 0.76 to 0.90.
Client satisfaction. The eight-item Client Satisfaction Ques-
tionnaire (CSQ-8) [29] assesses patient satisfaction. The CSQ-8
items can be scored on a scale from 1 (low satisfaction) to 4 (high
satisfaction), with labels specific to particular items. The total CSQ
score was obtained by averaging the items answered. Good
construct validity and internal consistency have been previously
reported [29]. Cronbach’s alpha was 0.86 in this study.
PLOS ONE | www.plosone.org
Internet-Based PST for Depression and Anxiety
In conformity with grade rating scales in Dutch education,
participants were also asked to give an overall satisfaction rating on
a scale from 1 (very bad) to 10 (excellent), followed by an open
question on how this rating could have been improved.
Help-seeking behavior. To examine possible help-seeking
in participants on the waiting list, adolescents were asked whether
they searched for and received professional help (and from whom)
for internalizing problems during the first 4 months of study
participation.
Statistical analyses
Missing values. All analyses were performed on the inten-
tion-to-treat sample. Baseline data were available for all partici-
pants. The Linear Mixed Modeling (LMM) procedure was used
for all analyses to estimate missing values. LMM includes
incomplete cases in the analysis and employs restricted maximum
likelihood estimation to calculate parameter estimates. LMM
assumes that missing data are missing at random.
Baseline differences and attrition. Baseline differences in
demographic and clinical characteristics were investigated using
Chi-square tests and t-tests. Attrition was defined as completing
none or one of the three post measures.
Effects
Treatment differences. LMM, using the variance compo-
nents covariance structure, was used to investigate treatment
differences. Time was treated as a continuous variable, condition
was treated as a fixed effect, and the intercept was included as a
random effect.
Recovery. For the CES-D total score, the standard cut-off
score of 16 was used as an indication of recovery. A HADS score
lower than 8 [30] was used as an indication of recovery. This was
calculated only for those participants who did meet these criteria at
baseline. The differences in recovery rate between the intervention
and control group were also calculated with binary logistic
regression.
3 August 2012 | Volume 7 | Issue 8 | e43485
 Internet-Based PST for Depression and Anxiety

Completion status. LMM was used to investigate differences months. Reasons for the high level of attrition were unknown.
in development of depressive symptoms between treatment There were no significant differences in attrition rates between
completers, non-completers, and WL. Time was treated as a groups. Participants who completed post measures were younger
continuous variable. The intercept was included as a random than participants who didn’t (15.46 and 16.89 years respectively,
effect. Completers were defined as respondents who completed all t(43) = 2.137, P = 0.038).
lessons. All analyses were conducted using SPSS for Windows
version 17.0. Effects
Treatment differences. Table 2 reports the means and
Results standard deviations for depression and anxiety for the intervention
and waiting list control group over 4 months. For depression, a
Participants significant overall improvement over time was found for the
Of the 378 adolescents who were potentially interested in complete sample on the CES-D, B = 22.31, SE = 0.86, P = 0.009.
participating, 312 adolescents did not give informed consent. From Neither significant group (B = 20.10, SE = 3.58, P = 0.978) nor
66 adolescents we received baseline questionnaires and written group x time interaction (B = 0.54, SE = 1.14, P = 0.637) effects
informed consent. Of these, 17 did score above the cut-off on were found. Regarding anxiety, no significant time (B = 20.73,
either the CES-D, HADS, or BDI suicide item, 1 already received SE = 0.39, P = 0.062), group (B = 20.06, SE = 1.57, P = 0.968) or
different treatment, and 3 withdrew without specifying a reason. group x time interaction (B = 0.25, SE = 0.51, P = 0.621) effects
The remaining 45 participants were randomized. Table 1 were found.
presents sample characteristics. Participants were mainly female Recovery. 36 participants suffered clinical levels of depression
(75.6%, n = 34). The mean age was 16.07 years (SD = 2.31). according to the CES-D at baseline (80% of total sample). 37.5%
Almost all participants were of Dutch origin (91.1%, n = 41). The of participants who completed post-measures had recovered at 5
mean score of all participants on the CES-D at baseline was 25.02 weeks and 25% had recovered at 4 months across both groups.
(SD = 9.06, range = 5–40), on the HADS 8.84 (SD = 3.60,
Regarding anxiety, 31 participants suffered clinical levels at
range = 2–14). Both averages are above cut-off scores for mild
baseline (68.9%). After 5 weeks, 60% had recovered while 52.4%
levels of depression and anxiety. In the 12 months before our
had recovered after 4 months. Recovery effects were not
baseline measurement, 45% of participants encountered any
significantly different between intervention and waiting list groups.
mood or anxiety disorder, with social phobia being the most
Treatment completers versus non-completers. Many
common (42%). There were no statistically significant differences
participants failed to complete the whole course. Of those
between the groups at baseline with respect to demographics,
participants assigned to the intervention condition, 10 (45%)
symptoms or diagnostic status (Table 1 and Table 2).
participants completed three or more lessons and 6 (27%)
completed all five. All but 1 participant completed the first lesson.
Attrition Completers were younger than non-completers (14.83 years versus
Attrition rates for the full sample were 37.8% (n = 17) at the 3- 16.94 years), t (20) = 22.20, P = 0.04. Regarding symptom
week assessment, 37.8% (n = 17) at 5 weeks, and 40% (n = 18) at 4 measures at baseline, no differences were found between
completers and non-completers.
Table 1. Sample characteristics at baseline. We investigated differences in development of depression and
anxiety scores between treatment completers, non-completers, and
waiting list condition. No differences were found in improvement
All PST WL of depressive and anxiety symptoms between completers and non-
(n = 45) (n = 22) (n = 23) Statistic completers. Moreover, we examined differences in development of
Age (years) 16.07 15.78 16.36 t (43) = 0.84, P = 0.405 depression and anxiety between participants who completed three
or more lessons, participants who completed less than three
Female 34 (75.6%) 15 (68.2%) 19 (82.6%) X2 = 1.27, P = 0.260
lessons, and participants on the waiting list. No differences were
Country of birth X2 = 0.002, P = 0.960
found in improvement of depression and anxiety.
The Netherlands 41 (91.1%) 20 (90.9%) 21 (91.3%) Client satisfaction. Table 3 provides an overview of the
Education X2 = 5.43, P = 0.066 CSQ items and the total scale score that were used to estimate
lower 17 (37.8%) 5 (22.7%) 12 (52.2%) participants’ satisfaction with the intervention. Given the 1–4
middle 14 (31.1%) 7 (31.8%) 7 (30.4%)
metric for the CSQ scale, participants expressed moderate
satisfaction (total score M = 2.51, SD = 0.55). The mean overall
higher 14 (31.1%) 10 (45.5%) 4 (17.4%)
satisfaction grade on a 1–10 scale was 6.45 (SD = 1.28) and 85% of
Diagnosis* participants reported grades of 6 or above. Fourteen participants
MD – past year 5 (15.2%) 3 (17.6%) 2 (12.5%) X2 = 0.170, P = 0.680 provided suggestions on how to improve the intervention which
MD – current 2 (6.1%) 0 (0%) 2 (12.5%) X2 = 2.262, P = 0.133 have been abstracted into five main suggestions. Suggestions were:
GAD – past year 2 (6.1%) 0 (0%) 2 (12.5%) X2 = 2.262, P = 0.133 better communication and guidance, more feedback from
supervisor and receiving emails when having received feedback
GAD – current 1 (3.0%) 0 (0%) 1 (6.3%) X2 = 1.096, P = 0.295
(adolescents now had to be logged onto the website in order to see
SP – past year 14 (42.4%) 9 (52.9%) 5 (31.3%) X2 = 1.588, P = 0.208 whether they got a response on their assignments) (n = 5), more
SP – current 4 (12.1%) 1 (5.9%) 3 (18.8%) X2 = 1.281, P = 0.258 clarity on what to do and why, a clearer website (n = 3), more
PAN 3 (9.4%) 2 (12.5%) 1 (6.3%) X2 = 0.368, P = 0.544 exercises and more elaborative on exercises, more exercises in
negative thinking (n = 3), more time to work on exercises,
*Presence of diagnosis occurring within the past 12 months (‘‘past year’’) extension of course length (n = 2), more originality in self-help
including the past 4 weeks (‘‘current’’). MD = Major Depression;
GAD = Generalized Anxiety Disorder; SP = Social Phobia; PAN = Panic Disorder
program (n = 1).
without Agoraphobia. Help-seeking. Eleven adolescents on the waiting list re-
doi:10.1371/journal.pone.0043485.t001 sponded on the question about possible help-seeking behavior

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 Internet-Based PST for Depression and Anxiety

Table 2. Outcomes on depression and anxiety.

Measure and treatment Baseline 3 weeks 5 weeks 4 months

condition M (S.D.) M (S.D.) M (S.D.) M (S.D.)

CES-D
PST 25.00 (8.22) 19.25 (7.21) 17.00 (9.17) 20.18 (10.39)
WL 25.04 (9.97) 21.88 (11.29) 17.47 (12.92) 19.75 (12.46)
HADS
PST 8.63 (3.22) 7.17 (3.04) 6.84 (4.60) 6.64 (5.73)
WL 9.04 (3.99) 7.56 (4.70) 6.20 (5.72) 7.50 (5.11)

Note. M = Mean; S.D. = Standard Deviation; PST = Problem Solving Therapy group; WL = Waiting List control group.
doi:10.1371/journal.pone.0043485.t002

during study participation. Two adolescents had received profes-
sional help from a psychologist.
Discussion
This is the first RCT examining the effects of preventive
Internet-based problem solving therapy (PST) for adolescents with
depressive and anxiety symptoms. Internet-based PST was
compared to a waiting list control group and intervention effects
were investigated over 4 months. Results show that depressive and
anxiety symptoms declined in both groups. However, no support
was found for the effects of Internet-based PST in reducing
depression and anxiety in comparison to the waiting list control
group, but the small sample size and high drop-out rate precluded
meaningful interpretation of this finding.
Previous research into the problem-solving treatment with an
adult population has found that the program obtains significant
effects [13,31]. Several explanations may be considered for not
finding any additional effect of PST above usual care for our
adolescent population. One reason for the lack of effects in this
study is that our intervention was not implemented precisely in the
way it was intended due to website problems. That is, the website
content was not presented in an optimally format which could
have caused difficulties for adolescents in understanding and
working through the intervention. Moreover, the intervention may
have lacked sufficient guidance and email support for some
participants because of technical difficulties in the email support
module. Six participants have encountered delayed feedback. Both
suppositions are supported by satisfaction reports and may have
Table 3. Means and standard deviations (S.D.) for each CSQ
item and total scale score (n = 21).
Item or scale Mean
Rate quality of service 2.67
Got the kind of service wanted 2.29
Program met needs 2.43
Recommend to a friend 2.23
Satisfaction with help received from supervisor 2.29
Helped deal more effectively with problems 2.76
How satisfied with service 2.86
Would come back to the program 2.33
Total scale score 2.51
doi:10.1371/journal.pone.0043485.t003
impacted completion status. The level of completers in our study
(27%) was relatively low compared to adult studies into web-based
self-help [31–33]. Differences in depression and anxiety outcomes
between completers and non-completers were not found, however.
Another reason for the non-significant findings here may be
reduced appropriateness of our intervention for this age group.
The self-help and individual format of our intervention requires
extensive self-discipline and motivation, and this may be too
informal in nature for treatment of adolescents. Also, depression
impacts on individuals’ motivation and their ability to concentrate
in a self-directed format [10]. It is also possible that PST may not
be attractive enough for adolescents, or the intervention may have
been of too high difficulty or of insufficient duration for problem
solving skills to become internalized to produce lasting effects.
A different possible reason for the lack of effects may be
participants’ severity of symptom levels at baseline. To illustrate,
most adolescents reported clinically significant levels of depression
or anxiety and several had encountered a mood or anxiety
disorder in the past 12 months. Possibly, the PST intervention is
not suitable for adolescents with more severe symptoms.
Finally, we should note that participants in the waiting list
control condition may have attended other treatments during the
study, possibly affecting our results. Two out of 11 waiting-list
participants received other treatment. Although it is not clear to
what extent this may have affected the results, our results are
vulnerable to many influences considering our small sample size.
The present study has a number of significant strengths. The
study is one of only a small number of randomized controlled trials
to date into web-based interventions for adolescents with
depression and anxiety. The intervention being examined required
minimal training of therapists and was relatively cheap to
administer, thereby increasing the probability that the intervention
would be sustained and distributed within mental health care
services. Moreover, reliable and valid measures of depressive and
anxiety symptoms were used, recruitment was widespread, and
S.D.
diagnostic status at baseline was assessed. However, limitations
0.66 should be noted. First, the sample size was very small and
0.90 questions could be raised about the representativeness of the
0.75 sample and the generalizability of our findings to the wider
0.73
population. Specifically, immigrants were fairly underrepresented
among participants, and we predominantly excluded early and
0.90
middle adolescents who were reluctant to request parental
0.77 consent. It is likely that participants differed in other important
0.73 ways from those who did not sign up for the study. Second, in
0.73 common with many other online interventions [34], we were faced
0.55
with a high attrition rate, possibly due to adolescents losing interest
in participating in the study. Another possible limitation is the use
of a wait-list control group in that it is unclear whether the

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prospect of receiving an intervention within a couple of months
could have influenced results. A final limitation is that demand
characteristics, such as receiving a telephone call when reporting
possible severe depressive or anxiety symptoms, may have affected
participant responses to the questionnaires.
Overall, the results of this study do not provide support for the
use and implementation of an Internet-based problem-solving
therapy for adolescents with depressive and anxiety symptoms.
Several explanations for this lack of effect may be provided. In
general, this study may have had inadequate power to demon-
strate effects and further research is needed to establish whether
web-based PST will be effective in adolescents if adapted or aimed
at a specific subgroup of adolescents. More research is required to
ascertain what intervention content, amount, timing, and duration
of delivery is most effective and for which group of adolescents
[35], as well as the potential of Internet-based interventions for
adolescents with internalizing symptoms.
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PLOS ONE | www.plosone.org
Internet-Based PST for Depression and Anxiety
Supporting Information
Checklist S1 CONSORT Checklist.
(DOC)
Protocol S1 Trial Protocol.
(PDF)
Acknowledgments
We would like to thank Prezens/GGZinGeest for supervising participants
in the PST intervention.
Author Contributions
Conceived and designed the experiments: WH JS HMK PC. Performed
the experiments: WH. Analyzed the data: WH. Wrote the paper: WH JS
HMK PC.
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 |
Received: 9 September 2016    Accepted: 13 September 2017

DOI: 10.1002/nop2.107

RESEARCH ARTICLE

Evaluating the parent–adolescent communication toolkit:

Usability and preliminary content effectiveness of an online
intervention

Elaine Toombs1  | Anita Unruh† | Patrick McGrath2

1
Department of Psychology, Lakehead
University, Thunder Bay, ON, Canada Abstract
2
Centre for Family Health, IWK Health Centre, Aim: This study aimed to assess the Parent–Adolescent Communication Toolkit, an
Halifax, NS, Canada
online intervention designed to help improve parent communication with their adoles-
Correspondence cents. Participant preferences for two module delivery systems (sequential and unre-
Elaine Toombs, Department of Psychology,
stricted module access) were identified.
Lakehead University, Thunder Bay, ON,
Canada. Design: Usability assessment of the PACT intervention was completed using pre-­test
Email: etoombs@lakeheadu.ca
and posttest comparisons. Usability data, including participant completion and satis-
Funding information faction ratings were examined.
No Funding to declare Methods: Parents (N = 18) of adolescents were randomized to a sequential or unre-
stricted chapter access group. Parent participants completed pre-­test measures, the
PACT intervention and posttest measures. Participants provided feedback for the in-
tervention to improve modules and provided usability ratings. Adolescent pre-­ and
posttest ratings were evaluated.
Results: Usability ratings were high and parent feedback was positive. The sequential
module access groups rated the intervention content higher and completed more con-
tent than the unrestricted chapter access group, indicating support for the sequential
access design. Parent mean posttest communication scores were significantly higher
(p < .05) than pre-­test scores. No significant differences were detected for adolescent
participants. Findings suggest that the Parent–Adolescent Communication Toolkit has
potential to improve parent–adolescent communication but further effectiveness as-
sessment is required.

KEYWORDS
Health, parent intervention, parent training, parent–adolescent communication, parenting,
web-based intervention

1 |  INTRODUCTION et al., 2003). These common adolescent parenting issues include
challenging of authority, increasing personal independence, sib-
Parent–adolescent conflict is common (Smetana, 2011). Most ling disagreements and negotiating new responsibilities (Laursen
conflicts that occur within the parent–adolescent relationship are & Collins, 2009; Smetana, 2011). To resolve these conflicts, par-
minor, but they differ from parenting of school-­aged children (Ralph enting practices may require modification, specifically within
parent–adolescent communication. Poor parent–adolescent com-
†
Deceased. munication is associated with detrimental parent and adolescent

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2017 The Authors. Nursing Open published by John Wiley & Sons Ltd.

Nursing Open. 2018;5:29–36. wileyonlinelibrary.com/journal/nop2 |  29

  
 |
30       TOOMBS et al.
health outcomes and can impact the choices an adolescent makes
(Resnick et al., 1997).
Increased and escalating conflict can impair the quality of the
parent–adolescent relationship (Smetana, 2011). The strength of the
parent–adolescent relationship can influence adolescent decisions re-
garding sex (Wilson & Donenberg, 2004), education (Hill et al., 2004),
alcohol use (Chaplin et al., 2012) and tobacco use (Tilson, McBride,
Lipkus, & Catalano, 2004). Positive parenting results in higher self-­
esteem, higher academic achievement and better emotional adjust-
ment for adolescents (Vasquez, Patall, Fong, Corrigan, & Pine, 2016).
A strong relationship between a parent and adolescent can protect
adolescents from emotional distress, suicidal thoughts and violence
(Resnick et al., 1997).
Adolescence can be a challenging developmental stage to parent
(Larson, Richards, Moneta, Holmbeck, & Duckett, 1996). Increased
conflict within a parent–adolescent relationship is associated with
higher levels of parental stress (Pasley & Gecas, 1984). Parents have
rate adolescence as the most difficult stage of parenting (Anderson,
2008). Parents of adolescents report lower levels of emotional func-
tioning, less competence, lower self-­esteem and less life satisfac-
tion, compared to parents of younger children (Larson et al., 1996).
Additional factors increase parental stress such as adolescent mental
health concerns, parent health status, family poverty or lack of par-
enting supports (Anderson, 2008). These issues can reduce the use
of effective parenting techniques, reduce parent–adolescent conflict
resolution, and increase the likelihood of detrimental adolescent out-
comes (Smetana, 2011).
Despite increased stress within parent–adolescent relationships,
there are few accessible supports available to meet the needs of these
parents. Effective parent interventions to improve parent–adolescent
relationships, reduce parental stress and improve parent–adolescent
communication are required. Parenting training programs can be
difficult to obtain for many families due to location of the service,
cost and waiting lists (McGrath, Lingley-­Pottie, Emberly, Thurston, &
McLean, 2009; Reid & Brown, 2008). Parents are often discouraged
by the treatment options available to them (Shanley, Reid, & Evans,
2008).
Available behavioural change parent training programs include
Adolescent ParentWays (Taylor et al., 2015), Triple P (Nowak &
Heinrichs, 2008) and Parenting Adolescents Wisely (Kacir & Gordon,
2000). Taylor et al. (2015) have argued that despite the effectiveness
of evidence-­based programs, further parenting solutions that are more
accessible, affordable and relevant, are required. Increasing options of
care and accessibility of parent training programs will lead to better
outcomes for families.
1.1 | The parent–adolescent communication toolkit
The Parent–Adolescent Communication Toolkit (PACT) is an online
intervention targeted at parents of adolescents to improve the com-
munication of parents with their adolescents, and their relationship.
The PACT intervention (Toombs, Unruh, & McGrath, 2013) was de-
veloped with close collaboration between parents of adolescents and
the research team. PACT takes principles from Gottman’s couple re-
lationship intervention (Declaire & Gottman, 2001; Gottman & Ryan,
2005; Gottman & Silver, 2015) and combines these with the Strongest
Families model of care (McGrath et al., 2009, 2011) to create a strat-
egy for parents to improve communication with their adolescents.
Table 1 briefly describes each module’s content.
PACT was modelled on Gottman’s relationship repair strategies
given the applicability of his relationship repair theories to a parent–ad-
olescent dyad with some modifications and the high success rate of this
relationship therapy. Simple communication strategies and practical sug-
gestions are combined with activities such as writing and self-­reflection
exercises for couples. Relationship repair skills can be implemented in-
dependently, without the aid of a therapist. By simplifying his research
findings, Gottman provided an alternative approach to traditional face-­
to-­face therapy (Gottman & Ryan, 2005). Many of Gottman’s couple
communication modules such as Nurturing Fondness and Admiration,
Creating Shared Meaning and Turning Towards Each Other (Gottman &
Silver, 2015) can be applied to a parent–adolescent dyad.
The Strongest Families empirically validated distance care model
(McGrath et al., 2009, 2011) for child mental health was used as a frame-
work for the PACT intervention. Strongest Families offers telehealth and
web-­based interventions to families requiring support for childhood
behavioural and anxiety disorders. Strongest Families programs imple-
ment programs for parents and children assisted by highly trained and
monitored non-­professional coaches that are reachable by telephone or
email. The Strongest Families program is highly effective at reducing typ-
ical treatment barriers that exist for families seeking support (McGrath
et al., 2011). Programs offer evidence-­based skills that are customized
to meet parent requirements. Strongest Families facilitates accessible,
convenient and confidential care, in a novel and effective approach to
family mental health treatment (McGrath et al., 2009, 2011).
By combining the Strongest Families model of care with Gottman’s
relationship repair strategies, the PACT intervention offers an alterna-
tive to traditional parenting interventions. It provides a low cost, con-
venient measure for parents seeking additional support for parenting
their adolescents without the stigma of seeking treatment. The inter-
vention normalizes parent–adolescent conflict, and provides specific
skills to reduce these concerns. By delivering the PACT skills online,
parents are able to seek information at their own pace, on their own
time. PACT is designed for parents to complete without the aid of a
therapist.
1.2 | PACT delivery via Individualized Research and
Intervention Software
The PACT intervention is delivered using Individualized Research and
Intervention Software (IRIS) technology. IRIS software facilitates the
creation of web-­based therapeutic mental health interventions in an
appealing and user-­friendly format. This platform was developed by
the Center for Research in Family Health research team, through a
grant funded by the Canadian Institute of Health Research. IRIS is cus-
tomizable and interactive for families, allowing personalized profiles
and content for participants, integrating demographic information
TOOMBS et al. |
      31

T A B L E   1   Summary of PACT module content

Section Module title Description

Introduction Outlines the program and the major features.

Assessment Taking the parent–adolescent How to determine where your conversations go wrong.
communication test
Building relationships
Module 1: Pay attention How to react positively to your adolescent’s attempts at emotional connection.
Module 2: Give affection and respect Expressing good feelings about your adolescent through compliments, praise and
positive observations.
Module 3: Create shared meaning Finding shared Creates greater stability in relationships, allows pursuit of goals
together.
Create rituals to connect, have symbolic and emotional meaning.
Module 4: Give goals room to grow Recognize and honour the dreams and feelings within your adolescent.
Module 5: Accept your teen and his/her influence Be open to persuasion from your adolescent without giving in.
Module 6: Accept one another Accept your adolescent for who he or she is, not the person you want him/her to be
Positive communication
Module 7: Compromise Avoid gridlocking by working out a decision that both you and your adolescent can
agree upon and be happy with.
Module 8: Start softly Learn to start talking about a complaint without criticizing or insulting.
Module 9: Repair your communication Deescalate negative feelings during a difficult encounter with your adolescent.
Turn around negative communication (Module 10)
Criticism Avoid attacking your adolescent’s personality or character rather than specifics.
Contempt Avoid insulting and psychologically abusing your adolescent.
Stonewalling Avoid removing yourself from the conversation mentally.
Defensiveness Avoid defending yourself from insults. Nine main strategies.
Flooding Avoid overwhelming your adolescent with too many complaints.
Talk about difficult issues (Optional Module 11)
Using the intervention skills to talk to your adolescent about sex, drugs, divorce and
mental health. Offers additional resources based on these.
Summary Summarizes the program and how to solve problem.

with health indicator behaviour inputs. The features IRIS offers, such
as messaging services, email reminders and discussion boards, allows
for customizable intervention content to suit the specific needs of the
PACT intervention (Wozney et al., 2016).
To meet study demands, IRIS can modify the intervention content
presentation, order and time of presentation. IRIS can deliver ques-
tionnaires, collect data and offer study completion reminders to partic-
ipants. The software can track participant activity, such as time spent
on each page and will track participant progress and activity by date.
1.3 | The purpose and hypotheses of this study
The main purpose of the current study was to assess the usability of
the new content and online format of PACT. We assessed the inter-
vention usability using parent feedback to provide ideas regarding
potential improvements, and alternative constructs that could bet-
ter facilitate participant learning in future modifications to the PACT
intervention.
PACT is a new intervention and the method of presenting the
intervention content had not been assessed. The second aim of this
study was to assess two different methods of intervention content
delivery to yield the best participant outcomes possible. Participants
were randomly assigned to either a sequential method of content de-
livery, meaning content must be completed in a rigid, predetermined
order, or participants had unrestricted access. Participants with un-
restricted module access completed modules in any order of choice
independent of previous modules completed. Unrestricted module
access provided more freedom but could affect how the PACT skills
were learned.
Given that PACT is a novel intervention, a peripheral aim of this
study was to assess outcomes of PACT for parents and adolescents’
communication scores during a 6-­week study duration. Exploratory
analyses examined the differences between parent–adolescent
communication scores before and after completion of PACT were
completed to provide preliminary information about the potential
for effectiveness of the intervention in a larger study. To determine
the preliminary effectiveness of PACT, parent and adolescent scores
were analysed separately. Parent and adolescent depression, stress
and anxiety scores were analysed using paired t tests. These mea-
sures were taken to determine if PACT influenced the emotional
 |
32       TOOMBS et al.

functioning of participants. In summary, the hypotheses for this 3 | MATERIALS

study were:
• Parent usability ratings for the PACT content delivered using the
IRIS platform would be high.
• Parents randomized to the sequential module access would have
higher completion rates and usability ratings than those randomized
to the unrestricted module access group.
• Parent and adolescent would use significantly more positive com-
municational strategies following the PACT intervention, as rated
by the IWK-PACC and emotional functioning (DASS) posttest
scores would be significantly higher than pre-test scores.
2 |  METHOD
This study was completed using a pre–posttest design with a 6-­week
intervention. Parent participants were randomized into two groups—
sequential chapter access or unrestricted module access. Figure 1 is a
diagram of the study design.
2.1 | Study randomization
All parent participants completed identical PACT content, although
how the intervention content was delivered was randomly assigned.
Parents either had unrestricted module access or sequential module
access, with each module unlocked only after completion of the previ-
ous module.
3.1 | Website
The study was conducted using a customized IRIS web-­based plat-
form. All usability questionnaires and intervention content were
presented using IRIS. Parent participants completed usability study
portion (content presentation, data collection and preliminary descrip-
tive analyses) entirely through the PACT website.
3.2 | Study measures
Four questionnaires were administered. These included the IWK-­
Parent–Adolescent Communication Checklist (Unruh, Bagnell, Huguet,
& Mcgrath, 2011), the Parent–Adolescent Communication Scale (PACS)
(Barnes & Olson, 1985), the Depression Anxiety Stress Scale (DASS-­
21) (Lovibond & Lovibond, 1995), and the Perceived Health Web Site
Usability Questionnaire (PHWSUQ) (Nahm, Preece, Resnick, & Mills,
2004). The PACS is a well-­established parent–adolescent communica-
tion measure and shows high alpha reliabilities of 0.87 and 0.78, with
test–retest reliabilities of 0.78 and 0.77 (Barnes & Olson, 1985). The
DASS-­21 was chosen as a short measure of emotional distress with
high internal consistency (Lovibond & Lovibond, 1995).
3.3 | Participants
Eighteen parent–adolescent dyads completed the study. Adolescent
participants were between the ages of 13–17 years and were a resi-
dent in their parent’s home. Parent participants agreed to commit to

PACT
Eligible & intervention Posttest
consented Pretest measures
(including
measures
(N = 18 dyads) usability (N = 16 dyads)
measure)
Sequential chapter
access
Randomization

(N = 8)
IWK-PACC IWK-PACC
Parents
PACS PACS
150 Posters (13 female, 5 male)
25 responses

DASS-21 Non-sequential DASS-21

distributed chapter access
in (N = 10)
community
IWK-PACC IWK-PACC
Adolescents
PACS
No adolescent PACS
(13 female, 5 male)
DASS-21
completion DASS-21

F I G U R E   1   Participant flow and research design diagram

TOOMBS et al. |
      33

the 6 weeks required of the study. A convenience sample of 20 dyads,

recruited by word of mouth in the community, was chosen to assess
the overall usability for this pilot study and for this sample to pro-
vide in depth comments on aspects of the intervention that should
be modified before further implementation. Two dyads completed
consent and were randomized, but did not complete any intervention
content. Exploratory analyses completed from this sample were used
to determine significant trends in the data in relation to the effective-
ness of the intervention.
No parent had participated in another parenting or communication
behavioural intervention (including any prior PACT study), or received
support for a mental health problem in the previous 6 months. Parents
who reported any severe psychological impairment for themselves
or their adolescent were excluded from the study. All parent partic-
ipants had access to the Internet. Only one parent–adolescent dyad
per family could participate. Parent participants were primarily birth
parents, well educated (most achieved a 2-­year college diploma or
higher) and had a secondary parent in their family. No parents earned
less than $20 000 per year. Parent–adolescent dyads were primarily
mother-­daughter.
4 | RESULTS
4.1 | Hypothesis 1: Parent usability ratings of PACT
delivered using the IRIS platform would be high
Participant usability module ratings were rated highly by both par-
ticipant groups with Table 2 depicting the mean module ratings for
the sequential access and unrestricted access participant groups.
The total ratings per each of the 10 modules (obtained by aver-
aging all participant raw scores for each chapter) were analysed
using a one-­way ANOVA and did not differ significantly from one
another at the p < .05 level for the ten modules [F (9, 98) = 0.434,
p = .914)].
4.1.1 | Participant usability feedback
Parents provided written feedback for each module. Few modifica-
tions were suggested. Parents found the “Relationship Memory Bank”
and “Being Specific with Praise” particularly helpful. The audio-­visual
of the intervention content was difficult to access on tablets and
phones, and greater diversity in the family’s illustrated in the videos
was recommended. Parents also suggested the number of questions,
the number of examples, and the repetitive content be reduced.
4.2 | Hypothesis 2: Parents randomized to the
sequential module access group would have higher
completion and usability ratings than parents in the
unrestricted module access group
Two dyads did not complete the posttest study questionnaires and
were removed from subsequent analyses. Remaining parent par-
ticipants varied on module completion rates, with eight participants
(50%) completing all ten modules of PACT. Modules of PACT are dis-
persed in four sections. Sixty-­two percent of participants completed
the first section, and 50% completed sections two, three and four.
Participation decreased by 50% after Module 4. Figure 2 depicts
the percentage of parent participants who completed each module
by randomization to the sequential or unrestricted module access
groups.
Participant global usability ratings by each access group were an-
alysed to determine if the sequential module access group rated the
content higher than the unrestricted module access group. These
global ratings were obtained by adding participant scores across mod-
ules and dividing by the total score possible for how many modules
each completed. An independent t test detected significant differ-
ences [t(5) = 2.486, p = .027] between the sequential (M = 0.9339,
SD = 0.09395) and unrestricted module access groups (M = 0.8056,
SD = 0.09440) at a p < .05 level of significance.

T A B L E   2   Mean usability module ratings by participant group and 4.3 | Hypothesis 3: Parent and adolescent posttest
total scores communication and emotional functioning scores
would be significantly higher than their pre-­test scores
Sequential Unrestricted
module access module access Total
M (SD) M (SD) M (SD)
4.3.1 | Adolescent participant outcomes
Module (N = 6) (N = 10) (N = 16) Adolescent pre-­test and posttest communication ratings did not
Module 1 73.20 (4.82) 61.56 (5.32) 65.71 (7.62) significantly differ for both the IWK-­PACC [t(15) = 1.626, p = .125]
Module 2 71.40 (8.20) 61.80 (7.19) 65.00 (8.63) and the PACS [t(15) = 1.478, p = .160]. Depression [t(15) = 1.549,
Module 3 73.20 (6.10) 60.90 (8.85) 65.00 (9.85) p = .142] and stress [t(15) = 1.612, p = .128] scores did not differ.
Module 4 72.2 (10.73) 59.86 (9.89) 65.00 (11.65) Anxiety posttest scores were significantly lower than pre-­test scores

Module 5 72.00 (10.10) 63.30 (9.24) 67.8 (10.14) [t(15) = 2.394, p = .03].

Module 6 69.20 (10.96) 63.00 (7.00) 66.10 (9.27)

Module 7 76.00 (1.73) 66.00 (8.03) 69.75 (8.03) 4.3.2 | Parent participant outcomes
Module 8 76.33 (1.15) 65.00 (7.84) 69.25 (8.36)
Paired t tests found posttest scores to be significantly higher than
Module 9 76.00 (1.73) 63.80 (9.20) 68.38 (9.44)
pre-­test scores for both the IWK-­PACC [t(15) = 2.689, p = .017]
Module 10 77 (0.00) 64.00 (7.78) 68.88 (8.94)
and the PACS [t(15) = 3.168, p = .006]. Emotional functioning for
34       | TOOMBS et al.

Number of participants completing each module 18

some devices (e.g., tablets and smart phones) and partially impaired
16
Sequential module access (N = 6) their completion of this PACT content. More audio-­visual components
14

were requested, depicting a greater variety of family structures, and

Unrestricted module access (N = 10)
12
Total (N = 16)
10 communication situations, as videos only showed interactions within
8
a mother–daughter dyad. Parent responses indicated that the content
6
was somewhat repetitive. Small modifications to PACT to address this
4

2
feedback are required before the next phase of testing.
0 Parents who were randomized into the sequential module access
Module 1 Module 2 Module 3 Module 4 Module 5 Module 6 Module 7 Module 8 Module 9 Module 10
completed more content and rated the usability of PACT higher than
Module number
participants in the unrestricted module access group. The significantly
F I G U R E   2   Percentage of participant PACT module completion higher usability ratings by the sequential module access group provide
support for this type of structure for PACT. The sequential access style
[t(15) = −0.194, p = .849], depression [t(15) = −0.831, p = .419] or of content delivery, often called tunnelling, decreases distraction of
stress scores [t(15) = −1.263, p = .226] was not significant. the user and ensures the user completes necessary content (Danaher,
Comparisons of the sequential and unrestricted chapter access McKay, & Seeley, 2005). Due to both high usability ratings and in-
groups found no significant differences. Repeated measures analysis creased benefits noted by participants, the sequential module access
of variance (ANOVA) tests found no significant differences between is the recommended style of information architecture.
group pre-­ and posttest scores of the IWK-­PACC [F(2,29) = 1.736, Increased completion rates of the sequential module access also
p = .194] and the PACS [F (2,29) = 0.520, p = .600]. support the use of this design in future studies. Parents in the sequen-
tial module access group completed more of the PACT content than
those randomized to the unrestricted module access group. Only two
4.3.3 | IWK-­PACC subscale results
parents or 11% of participants did not complete all of the modules in
IWK-­PACC was divided into three primary subscales: Building comparison to a previous PACT study (unpublished data) in which six
Closeness and Admiration (BCA), Reducing and Repairing Conflict participants (30%) did not complete all modules.
(RRC) and Increasing Conflict (IC). The two communication scales, Participant retention is a priority for future studies of PACT. Fifty
BCA and RRC, were combined and the negative IC was reverse scored percent of the parent participants did not continue the intervention
to produce a total IWK-­PACC communication total. Table 3 provides after module 4 even though this module was rated as highly as the
mean participant scores for the IWK-­PACC and the PACS. earlier modules. Many web-­based interventions have similar attrition
The three primary subscales of the IWK-­PACC (Building Closeness rates (Eysenbach, 2005) and low completion rates reduce the oppor-
and Affection, Reducing and Repairing Conflict and Increasing Conflict) tunity to achieve strong program outcomes. More email reminders
were analysed using a repeated measures ANOVA to determine if sig- from PACT could be provided through an automated IRIS system. The
nificant differences exist between pre-­test and posttest scores for attrition rate may also have been influenced by parents’ perception of
both parent and adolescent participants. It was found that there were content repetition for modules four and five where skills are applied
no significant differences between the three IWK-­PACC subscales for in more complex communication. Streamlining of content to reduce
either parent [F (2, 1) = 184.544 p = .745] or adolescent participants [F repetition will be helpful.
(2, 1) = 243.513 p = .137] at a p < .05 level of significance. PACT presents foundational skills related to building a positive re-
lationship before more challenging skills designed to reduce conflict.
Parents, who had have a more positive relationship with their adoles-
5 | DISCUSSION cent, may not have found the foundational skills of sufficient interest
to continue to the subsequent modules. Although PACT was cus-
Participant usability ratings of PACT in this study were encouraging. tomized through IRIS, it is possible further personalize PACT to meet
Parents rated all of the PACT modules quite highly, thus supporting individual parent needs. IRIS uses algorithms to modify the content
Hypothesis 1, with a small decreased rating for the audio-­visual con- presentation to parents based on prior responses to questionnaires. If
tent. Parents rated PACT as easy to use, the content to be relevant parents completed pre-­test assessments online, particularly the IWK-­
and easy to learn. All modules were rated highly. The only consistent PACC (as the IWK-­PACC directly assesses each of the PACT interven-
feedback provided by parents was that the videos did not work on tion module skills), IRIS can combine scores and determine internally

T A B L E   3   Mean Participant Pre-­test and

Parent pre-­test Teen pre-­test M Parent posttest M Teen posttest
Posttest Scores for IWK-­PACC and PACS
Measure (Max) M (SD) (SD) (SD) M (SD)

PACS total (50) 15.13 (9.45) 9.94 (10.07) 20.06 (9.91) 13.00 (9.90)
IWK-­PACC total 111.19 (52.41) 139.50 (50.10) 133.00 (43.21) 152.82 (50.08)
(204)
TOOMBS et al.
the most applicable content for each parent. Further customization of
content would increase participation and reduce potential boredom,
frustration or dissatisfaction with skills.
Increased customization may also decrease attrition rates when
combined with the sequential chapter access design due to increased
relevancy and structure of the content. A systematic review by
Christensen, Griffiths, and Farrer (2009), found that participation rates
for randomized control trials were often much higher (ranging from
50% to 99% completion) than those for open access websites (ranging
from 1% to 50%), of web interventions aimed to reduce depression
symptoms. Using a sequential access design can result in better user
experience, by increasing researcher control of content.
Emotional health of parents and adolescents was generally not
affected by parent completion of PACT. The IWK-­PACC and PACS
posttest communication measures for parents were significantly
higher than pre-­test scores demonstrating that communication with
their adolescent had improved. There was no significant difference in
adolescents’ pre-­ and posttest scores on the IWK-­PACC or the PACS
likely due to the high pre-­test scores. Most adolescents in this study
already had strong relationships with their parent before the interven-
tion. Similarly, pre-­test scores on the DASS-­21 for parents and adoles-
cents indicated low stress, anxiety and depression and these scores
were not significantly changed by PACT.
Fathers tend to be less willing to participate in parenting inter-
ventions and often have a much higher attrition rate and lower sat-
isfaction than mothers (Lee & Feldgaier, 2015). In this study, five of
the 18 parents were fathers. They did not identify any gaps in the
PACT content but the small sample size did not permit comparison
by gender.
5.1 | Study limitations
The main limitation of this study was the small sample size and inclu-
sion of parent–adolescent dyads with relatively strong relationships
at study outset. During the recruitment phase, six parents expressed
interest in completing the research study but could not participate
due to the unwillingness of their adolescent.
6 | CONCLUSION
This study confirmed the usability of the PACT intervention and pro-
vided evidence for the best structural architecture for content deliv-
ery. Participants identified modifications to the intervention content
to improve it for future use. Exploratory analyses of change in parents’
perceptions of their relationship with their adolescent following PACT
indicated that the PACT intervention may be a viable tool for improv-
ing parent–adolescent communication.
ET H ICAL APPROVAL
Ethical approval for this study was obtained from the Research Ethics
Board at the IWK Health Centre, in Halifax, Nova Scotia, Canada.
|
      35
AU T HO R CO NT R I B U T I O NS
Elaine Toombs, MA, is a Clinical Psychology graduate student at
Lakehead University. This project was completed as part of her the-
sis requirements for a Masters of Arts (Health Promotion) degree at
Dalhousie University. Ms Toombs participated in study design, data
collection, data analysis, manuscript drafting and revisions.
Anita Unruh, PhD, was Ms. Toombs’ MA thesis supervisor.
She was a Professor and Associate Dean in the Faculty of Health
Professions at Dalhousie University. She contributed to all aspects
of this manuscript, including study conceptualization, design, data
interpretation, and initial manuscript revisions.
Patrick McGrath, OC, PhD, FRSC, FCAHS, is the Integrated
Vice President Research and Innovation for Capital District Health
Authority and IWK Health Centre. He is Professor of Science,
Paediatrics, Psychiatry and Community Health and Epidemiology, and
Canada Research Chair at Dalhousie University. Dr. McGrath sat on
Ms. Toombs’ thesis committee, and was involved in study conceptual-
ization, design, data interpretation and manuscript revisions.
All the Authors have agreed on the final version and meet at least
one of the following criteria [recommended by the ICMJE (http://
www.icmje.org/recommendations/)]:
• substantial contribution to conception and design, acquisition of
data or analysis and interpretation of data;
• drafting the article or revising it critically for important intellectual
content.
O RC I D
Elaine Toombs  http://orcid.org/0000-0002-9863-2713
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 Journal of Adolescent Health 59 (2016) S49eS60

www.jahonline.org

Review article

Interventions for Adolescent Mental Health: An Overview

of Systematic Reviews
Jai K. Das, M.D., M.B.A. a, Rehana A. Salam, M.Sc. a, Zohra S. Lassi, Ph.D. b, Marium Naveed Khan a,
Wajeeha Mahmood c, Vikram Patel, Ph.D. d, e, f, and Zulfiqar A. Bhutta, Ph.D. g, h, *
a
Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
b
Robinson Research Institute, University of Adelaide, Adelaide, Australia
c
Ziauddin University, Karachi, Pakistan
d
London School of Hygiene & Tropical Medicine, London, United Kingdom
e
Public Health Foundation of India, New Delhi, India
f
Sangath, Goa, India
g
Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
h
Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan

Article history: Received January 25, 2016; Accepted July 1, 2016

Keywords: Adolescent health; Mental health; Suicide; Depression; Anxiety; Eating disorders

A B S T R A C T

Many mental health disorders emerge in late childhood and early adolescence and contribute to the
burden of these disorders among young people and later in life. We systematically reviewed literature
published up to December 2015 to identify systematic reviews on mental health interventions in
adolescent population. A total of 38 systematic reviews were included. We classified the included reviews
into the following categories for reporting the findings: school-based interventions (n ¼ 12); community-
based interventions (n ¼ 6); digital platforms (n ¼ 8); and individual-/family-based interventions (n ¼ 12).
Evidence from school-based interventions suggests that targeted group-based interventions and cognitive
behavioral therapy are effective in reducing depressive symptoms (standard mean difference [SMD]: .16;
95% confidence interval [CI]: .26 to .05) and anxiety (SMD: .33; 95% CI: .59 to .06). School-based
suicide prevention programs suggest that classroom-based didactic and experiential programs increase
short-term knowledge of suicide (SMD: 1.51; 95% CI: .57e2.45) and knowledge of suicide prevention
(SMD: .72; 95% CI: .36e1.07) with no evidence of an effect on suicide-related attitudes or behaviors.
Community-based creative activities have some positive effect on behavioral changes, self-confidence,
self-esteem, levels of knowledge, and physical activity. Evidence from digital platforms supports
Internet-based prevention and treatment programs for anxiety and depression; however, more extensive
and rigorous research is warranted to further establish the conditions. Among individual- and family-
based interventions, interventions focusing on eating attitudes and behaviors show no impact on body
mass index (SMD: .10; 95% CI: .45 to .25); Eating Attitude Test (SMD: .01; 95% CI: .13 to .15); and
bulimia (SMD: .03; 95% CI: .16 to .10). Exercise is found to be effective in improving self-esteem (SMD:
.49; 95% CI: .16e.81) and reducing depression score (SMD: .66; 95% CI: 1.25 to .08) with no impact on
anxiety scores. Cognitive behavioral therapy compared to waitlist is effective in reducing remission (odds
ratio: 7.85; 95% CI: 5.31e11.6). Psychological therapy when compared to antidepressants have comparable
effect on remission, dropouts, and depression symptoms. The studies evaluating mental health

Conflicts of interest: The authors do not have any financial or nonfinancial competing interests for this review.
Disclaimer: Publication of this article was supported by the Bill and Melinda Gates Foundation. The opinions or views expressed in this supplement are those of the
authors and do not necessarily represent the official position of the funder.
* Address correspondence to: Zulfiqar A. Bhutta, Ph.D., Centre for Global Child Health, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M6S 1S6,
Canada.
E-mail address: zulfiqar.bhutta@sickkids.ca (Z.A. Bhutta).

1054-139X/Ó 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open access article under the CC BY license (http://
creativecommons.org/licenses/by/4.0/).
http://dx.doi.org/10.1016/j.jadohealth.2016.06.020
S50 J.K. Das et al. / Journal of Adolescent Health 59 (2016) S49eS60

interventions among adolescents were reported to be very heterogeneous, statistically, in their pop-
ulations, interventions, and outcomes; hence, meta-analysis could not be conducted in most of
the included reviews. Future trials should also focus on standardized interventions and outcomes for
synthesizing the exiting body of knowledge. There is a need to report differential effects for gender,
age groups, socioeconomic status, and geographic settings since the impact of mental health interventions
might vary according to various contextual factors.
Ó 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open access
article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Adolescence is a period for the onset of behaviors and con-
ditions that not only affect health at that time but also lead to
adulthood disorders. Unhealthy behaviors such as smoking,
drinking, and illicit drug use often begin during adolescence and
are closely related to increased morbidity and mortality and
represent major public health challenges [1]. Many mental
health disorders emerge in mid- to late adolescence and
contribute to the existing burden of disease among young people
and in later life [2]. More than 50% of adult mental disorders have
their onset before the age of 18 years [3,4]. Poor mental health
has been associated with teenage pregnancy, HIV/AIDS, other
sexually transmitted diseases, domestic violence, child abuse,
motor vehicle crashes, physical fights, crime, homicide, and
suicide [2]. Globally, neuropsychiatric disorders are the leading
cause of years lost because of disability among 10- to 24-year-
olds, accounting for 45% of years lost because of disabilities [5].
The overall prevalence of depression in adolescents is around 6%
and that for children (younger than 13 years) is 3% [6]. Major
depressive disorder (MDD) is one of the leading causes of
disability, morbidity, and mortality and is a major risk factor for
suicide [7]. MDD also puts adolescents and young adults at a
greater risk for suicide as they are seven times more likely to
complete suicide than those without MDD [8]. Suicide itself ac-
counts for 9.1% of deaths in 15- to 19-year age group and ranks as
the third major cause of mortality in this age group, preceded
only by accidents and assault [9].
Given the prevailing burden and impact of mental health
disorders in children and adolescents, it is essential that effective
interventions are identified and implemented. This article is part
of a series of reviews conducted to evaluate the effectiveness of
potential interventions for adolescent health and well-being.
Detailed framework, methodology, and other potential inter-
ventions have been discussed in separate articles [10e16]. Our
conceptual framework depicts the individual and general risk
factors through the life cycle perspective that can have implica-
tions at any stage of the life cycle [10]. We also acknowledge the
fact that mental health interventions take a life course perspec-
tive and that interventions earlier in life can have impacts in
adolescence; however, the focus of our review is to evaluate
potential mental health interventions targeted toward adoles-
cents and youth only. With this focus, we aimed to systematically
review the effectiveness of interventions to prevent and manage
mental health disorders among adolescents and youth.
studies targeted youth (aged 15e24 years) along with adoles-
cents, exceptions were made to include reviews targeting ado-
lescents and youth. We did not apply any limitations on the start
search date or geographical settings. We considered all available
published systematic reviews on the interventions to prevent
and treat adolescent mental health disorders. A broad search
strategy was used that included a combination of appropriate
keywords, medical subject heading, and free text terms; the
search was conducted in the Cochrane Library, and PubMed. The
abstracts (and the full sources where abstracts are not available)
were screened by two abstractors to identify systematic reviews
adhering to our objectives. Any disagreements on selection of
reviews between these two primary abstractors were resolved by
the third reviewer. After retrieval of the full texts of all the re-
views that met the inclusion/exclusion criteria, data from each
review were extracted independently into a standardized form.
Information was extracted on (1) the characteristics of included
studies; (2) description of methods, participants, interventions,
outcomes; (3) measurement of treatment effects; (4) methodo-
logical issues; and (5) risk of bias tool. We extracted pooled effect
size for outcomes reported by the review authors with 95%
confidence intervals (CIs). We assessed and reported the quality
of included reviews using the 11-point assessment of the
methodological quality of systematic reviews criteria (AMSTAR)
[17]. We excluded nonsystematic reviews, systematic reviews
focusing on preventive and therapeutic mental health in-
terventions targeting population other than adolescents and
youth, and reviews not reporting outcomes related to mental
health (Table 1).
Figure 1 describes the search flow. Our search identified 107
potentially relevant review titles. Further evaluation of the
abstracts and full texts resulted in the inclusion of 38 eligible
reviews. We classified the included reviews into the following
categories for reporting the findings:
 School-based interventions (n ¼ 12)
 Community-based interventions (n ¼ 6)
 Digital platforms (n ¼ 8)
 Individual-/family-based interventions (n ¼ 12)
Table 2 describes the characteristics of the included reviews
while Table 3 provides the summary estimates for all the
interventions.

Methods Results

We systematically reviewed literature published up to School-based interventions

December 2015, to identify systematic reviews on interventions
to prevent and manage mental health disorders in adolescent We found a total of 12 reviews reporting school-based
population. For the purpose of this review, the adolescent pop- interventions for adolescent mental health, of which one
ulation was defined as aged 11e19 years; however, since many review performed meta-analysis. AMSTAR rating ranged
 J.K. Das et al. / Journal of Adolescent Health 59 (2016) S49eS60
Table 1
Inclusion/exclusion criteria
Inclusion criteria
Systematic review and/or meta-analysis of interventions for
prevention and treatment of mental health targeting adolescents
(11e19 years) or youth (15e24 years):
Eating disorders
Anxiety
Depression
Suicidal behaviors
eHealth interventions focusing on adolescent/youth mental health
between 5 and 11 with a median score of 7.5. Five of the included
reviews focused on school-based mental health promotion
interventions; three reviews evaluated school-based programs
for prevention and early intervention for existing mental health
conditions while four reviews evaluated school-based programs
for suicide prevention. A review on school mental health pro-
motion programs based on the findings from 15 studies suggests
that an approach focusing on mental health promotion rather
than on mental illness prevention is effective in promoting
adolescent and youth mental health [18]. However, study pop-
ulations were limited, and studies either lack clarity regarding
who implemented interventions or lack theoretical foundations,
process evaluations, or youth viewpoints [18]. Meta-analysis was
not conducted due to variations in interventions and outcomes.
Another review reported from 27 studies that school-based
preventive health care is popular with young people and
provides important mental health services [19]. However,
meta-analysis was not done due to study quality. Findings from a
review based on 16 studies focusing on targeted group-based
interventions delivered in school settings suggest that nurture
groups (short-term, focused intervention which addresses
Figure 1. Search flow diagram. MeSH ¼ Medical Subject Heading.
S51
Exclusion criteria
Nonsystematic reviews
Systematic reviews focusing on preventive and therapeutic mental
health interventions targeting population other than adolescents and youth
Reviews not reporting outcomes related to mental health
barriers to learning arising from social, emotional, or behavioral
difficulties in an inclusive, supportive manner) have an imme-
diate positive impact on the social and emotional well-being of
young people [20]. Due to heterogeneity of design, it was not
possible to conduct a meta-analysis, and the studies were
examined for effectiveness qualitatively. A review evaluating
solution-focused brief therapy in schools has suggested mixed
results with some promise in working with students in school
settings, specifically for reducing the intensity of students’
negative feelings, managing conduct problems, and externalizing
behavioral problems [21]. These findings are based on seven
studies while meta-analysis could not be conducted. School-
based mental health interventions specifically focusing on low-
and middle-income countries (LMICs) suggest that the majority
of the school-based life skills and resilience programs indicated
positive effects on students’ self-esteem, motivation, and
self-efficacy. However, there were mixed results, including dif-
ferential effects for gender and age groups [19], and effect
estimates could not be pooled. A systematic review on the
effectiveness of school nurse implemented mental health
screening for adolescents in schools did not find any evidence of
Table 2

S52
Characteristics of the included reviews

Intervention Review Intervention details Setting; Number of AMSTAR Outcomes reported

HICs/LMICs included studies rating

School-based O’Mara and Lind [18] Social and emotional health and well-being, positive
interventions youth development, health promotion, mental
health promotion, primary prevention
Mason-Jones School-based health care including comprehensive
et al. [19] services based at schools, dedicated adolescent health
services, school-linked services based at local health
centers, and servicing a number of schools and other
Mostly HICs 15 reviews d Subclinical internalizing and externalizing
problems, academic achievement, mood
disorders, anxiety, depressive symptoms,
self-concept, self-esteem, coping skills,
interpersonal skills, quality of peer and
adult relationships, self-control, problem-
solving, self-efficacy, school misbehavior,
aggressive behavior and violence,
interpersonal sensitivity, conflict resolution,
school attendance, social functioning
HICs 27 (RCTs and 7 Utilization of mental health services,
observational ever considered suicide, attempted suicide
studies)

J.K. Das et al. / Journal of Adolescent Health 59 (2016) S49eS60

outreach
Cheney et al. [20] Nurture group (NG) intervention delivered in primary HICs 16 (RCTs and 8 Social and emotional well-being
and secondary school settings. NG sessions typically preepost)
include circle time meet and greet. A directed activity,
aiming to develop cooperation, listening, teamwork,
turn-taking, problem-solving, and self-esteem. Snack
time. Free time to choose an activity from the range
offered. Saying good-byes
Kim and Franklin [21] Solution-focused brief therapy on behavioral problems HICs 7 (RCT, quasi, 6 Changes in scores from Hare Self-Esteem
in schools and case Scale; Conners’ Teacher Rating Scale;
report) Conners’ Parent Rating Scale;
Feelings, Attitudes and Behaviors Scale
for Children; Substance Abuse Subtle
Screening Inventory Adolescent-2; and
Child Behavior Checklist-Youth.
Fothergill et al. [22] Screening tools being used by school nurses for the HICs None 6 Existing screening tools being applied
identification of emotional, psychological, and by school nurses to detect mental ill health
behavioral problems among adolescents in schools.
Calear and School-based prevention and early intervention HICs 42 RCTs 7 Depression
Christensen [23] programs for depression. Mostly including cognitive
behavioral therapy (CBT) delivered by a mental health
professional or graduate student over 8e12 sessions.
Other common therapeutic approaches employed
included psychoeducation and interpersonal therapy
Kavanagh et al. [24] Cognitive behavioral therapy HICs 17 RCTs 8 Outcome related to depression, anxiety,
and suicidality (actual or attempted
suicide and suicidal ideation)
Farahmand et al. [25] Day therapy programs: a multidisciplinary community- HICs 29 programs 7 Academic outcomes, behavioral outcomes,
based approach to the treatment of mental health issues conduct problems, depression, substance
use, internalizing symptoms
Katz et al. [26] School-based suicide prevention programs: HICs 16 programs 5 Students’ and school staffs’ knowledge and
awareness/education curriculum, gatekeeper training, attitudes toward suicide, suicide attempts
peer leadership training, screening, skills training,
reconnecting youth, good behavior game
De Silva et al. [27] Psychological interventions for suicide and self-harm HICs 38 controlled 6 Mapping of existing literature
prevention studies and 6
systematic
reviews
(continued on next page)
Table 2
Continued

Intervention Review Intervention details Setting; Number of AMSTAR Outcomes reported

HICs/LMICs included studies rating

Harrod et al. [28] Any intervention that (1) targeted students without HICs 8 RCTs 11 Completed suicide, suicide attempt, suicidal
known suicidal risk (i.e., primary prevention); (2) ideation, changes in knowledge, attitudes
had the prevention of suicide as one of its primary and behaviors
purposes; and (3) was delivered in the postsecondary
educational setting in any country
Harlow and Suicide prevention programs that have been evaluated HICs 11 programs 6 Suicide ideation, knowledge, attitude
Clough [29] for indigenous youth
Community-based Bungay and Music, dance, singing, drama and visual arts, taking Mostly HIC except 20 (RCTs and 5 Behavioral changes, self-confidence,
interventions Vella-Burrows [30] place in community settings or as extracurricular one in Tanzania observational) self-esteem, levels of knowledge,
activities and physical activity
Waddell et al. [31] Parent training or child social skills training and HICs 15 RCTs 6 Conduct disorder, anxiety, and depression
universal cognitive behavioral therapy (CBT)
Durlak and Primary prevention intervention designed specifically HICs 144 programs 5 Competencies, performance, successful transitions
Wells [32] to reduce the future incidence of adjustment problems

J.K. Das et al. / Journal of Adolescent Health 59 (2016) S49eS60

in currently normal populations, including efforts
directed at the promotion of mental health
Farahmand Community-based mental health and behavioral HICs 33 (RCTs and 4 Psychological, behavior, achievement, school
et al. [33] programs observational) connectedness, antisocial behavior,
interpersonal, social skills community
or prosocial activities, physical health
Bower et al. [34] Effectiveness of interventions for child and adolescent HICs RCTs and pree 7 Clinical outcomes, social, educational, satisfaction
mental health problems in primary care, and post studies with treatment, costs, attitudes, knowledge,
interventions designed to improve the skills of diagnostic and treatment behavior, costs
primary care staff
Digital platforms Clement et al. [35] It was a mass media intervention, defined as an HICs 22 RCTs 11 Discrimination or prejudice outcome measures
intervention that uses a channel of communication
intended to reach large numbers, and is not
dependent on person-to-person contact, for example,
newspapers, billboards, pamphlets, DVDs, television,
radio, cinema, some Web- and mobile phoneebased
media, street art, and ambient media
Musiat and Computerized cognitive behavioral therapy (cCBT) HICs 101 (observational 4 Cost-effectiveness, geographic flexibility, time
Tarrier [36] interventions studies) flexibility, waiting time for treatment, stigma,
therapist time, effects on help-seeking and
treatment satisfaction
Montgomery Media-based cognitive behavioral therapies HICs 11 RCTs 11 Behavioral disorders, therapist time
et al. [27]
Clarke et al. [38] Online mental health promotion and prevention HICs 28 observational 6 Anxiety, depression
interventions studies
Calear and Christensen BRAVE for ChildrendONLINE and BRAVE for Teenagersd HICs 4 programs 9 Anxiety and depression
2010 [39] ONLINE: based on cognitive behavioral therapy (CBT),
these programs consist of 10 weekly sessions for
children and adolescents; two booster sessions
presented 1 and 3 months after the intervention, and
five or six parent sessions. The programs present
information on managing anxiety, recognizing the
physiological symptoms of anxiety, graded exposure,
and problem-solving techniques.
Project CATCH-IT is a free, Internet-based training
program based on behavioral activation, CBT, and
interpersonal psychotherapy.
(continued on next page)

S53
Table 2

S54
Continued

Intervention Review Intervention details Setting; Number of AMSTAR Outcomes reported

HICs/LMICs included studies rating

MoodGYM is a free, interactive, Internet-based program

designed to prevent and decrease symptoms of
depression in young people.
Grip op je dip online is a free, Dutch language, CBT-based
program aimed at 16- to 25-year-olds. Based on the
face-to-face Grip op je dip course, the online program
consists of six moderated chat sessions attended by six
to eight participants.
Kauer et al. [40] Online services in facilitating mental health help-seeking HICs 18 (RCTs and 9 Help-seeking, mental health
observational
studies)
Martin et al. [41] Networked communication: e-mail and/or Web-based HICs 12 (RCTs and 9 Clinical outcomes (e.g., symptom alleviation),
electronic diary; videoconference; and virtual reality. observational patient-level impacts (e.g., improved health
studies) behaviors), patient and health care

J.K. Das et al. / Journal of Adolescent Health 59 (2016) S49eS60

professional satisfaction and costs
Farrer et al. [42] A range of broad technology types including the Internet, HICs 27 RCTs 9 Depression, anxiety
audio, virtual reality, video, stand-alone computer
programs, and/or a combination of these
Individual-/family- Pratt and Eating disorder awareness, promotion of healthy eating HIC 12 RCTs 8 BMI, Eating Attitude Test, Eating Disorder
based Woolfenden [43] attitudes and behaviors, as well as eating disorder Inventory, Sociocultural Attitudes Towards
interventions awareness and coping with general adolescent issues, Appearance Questionnaire, social perception
training in media literacy and advocacy skills profile, body image assessment
Ekelend et al. [44] Gross motor, energetic activity, for example, running, Mostly HIC except 23 RCTs 8 Self-esteem
swimming, ball games and outdoor play of moderate one in Nigeria
to high intensity, or strength training, in contrast to
“ordinary” physical activity (e.g., routine physical
education (PE) classes, walking to school, or playtime
activities of low intensity) for at least a duration of
4 weeks
Lubans et al. [45] Three types of physical activity programs (i.e., outdoor HICs 15 (RCTs, quasi, 9 Social and emotional well-being
adventure, sport and skill-based and physical fitness and preepost)
programs)
Cooney et al. [46] Exercise was defined as “planned, structured and Mostly HICs except 39 RCTs 11 Depression, acceptability of treatment,
repetitive bodily movement done to improve or one in Thailand, number of participants completing the
maintain one or more components of physical fitness” one in Brazil interventions; quality of life; cost; adverse
events
Larun et al. [47] Interventions that included vigorous physical activity HICs 16 RCTs 11 Anxiety or depression symptoms
of clearly specified quality with a minimum duration post-treatment
of 4 weeks
James et al. [48] (1) The relative efficacy of CBT versus non-CBT active HICs 41 RCTs 11 Remission, reduction in anxiety symptom,
treatments; (2) the relative efficacy of CBT versus acceptability
medication and the combination of CBT and
medication versus placebo; and (3) the long-term
effects of CBT
Cox et al. [49] Any psychological therapy with any antidepressant HICs 11 RCTs Remission from depressive disorder,
medication; a combination of interventions acceptability, suicide-related serious
(psychological therapy plus antidepressant adverse events, dropouts
medication) with either psychological therapies or
antidepressant medication alone; a combination of
interventions (psychological therapy plus
antidepressant medication) compared with either
intervention (psychological therapy or
antidepressants) plus a placebo; and a combination
(continued on next page)
 J.K. Das et al. / Journal of Adolescent Health 59 (2016) S49eS60 S55

existing screening tools to detect mental ill health among

AMSTAR ¼ assessment of the methodological quality of systematic reviews criteria; BMI ¼ body mass index; HIC ¼ high-income country; LMIC ¼ low- and middle-income country; RCT ¼ randomized controlled
adolescents in schools [22].

symptoms, improvement in other symptoms

depressive symptoms, dropouts, secondary
A systematic review of 28 school-based prevention and early

readmissions, time to relapse, functioning,

Treatment efficacy, treatment acceptability,

psychological functioning, acceptability,

remittance, improvement in depressive
intervention programs for depression has shown some support

Measures of symptoms and functioning

Prevention of a second or next episode, for the implementation of depression prevention and early

Disease-specific symptoms, general

intervention programs in schools [23]. Most of these programs

Symptoms, knowledge, attitude

were based on cognitive behavioral therapy (CBT) and delivered
by a mental health professional or graduate student over 8e12
sessions. Indicated programs, which targeted students exhibiting
elevated levels of depression, were found to be the most effective
AMSTAR Outcomes reported

in reducing depressive symptoms with effect sizes ranging from

.21 to 1.40. Meta-analysis was not conducted. It was found that
morbidity

and cost CBT delivered to young people in secondary schools can reduce
the symptoms of depression (standard mean difference
[SMD]: .16; 95% CI: .26 to .05) and anxiety (SMD: .33; 95%
CI: .59 to .06) [24]. School-based therapeutic mental health
programs specifically targeting adolescents with existing mental
rating

health disorders in LMICs suggested negative effects for pro-

11

11

8
11

grams that targeted externalizing problems and were delivered

selectively to youth with existing problems. Distinctive charac-
included studies

observational

teristics of low-income, urban schools, and nonschool environ-

8 RCTs and
Number of

ments were emphasized as potential explanations for the

studies
25 RCTs

52 RCTs

findings [25].
9 RCTs

7 RCTs

School-based suicide prevention programs focused on

awareness/education curricula, screening, gatekeeper, peer
leadership, and skills training [26,27]. Interventions for primary
prevention of suicide in university and other postsecondary
HICs/LMICs

educational settings suggest that classroom-based didactic and

Setting;

experiential programs increased short-term knowledge of sui-

HICs

HICs

HICs
HICs

HICs

cide (SMD: 1.51; 95% CI: .57e2.45) and knowledge of suicide

prevention (SMD: .72; 95% CI: .36e1.07) with no evidence of an
effect on participant’s suicide-related attitudes or behaviors;
however, these findings are limited by the overall low quality
[28]. Promising interventions that need further research include
skills training assertiveness training, relaxation
antidepressant medication) with a placebo or

Mental health services providing specialist care,

Behavioral therapy, behavioral activation, social

school-based prevention programs with a skills training

Any type of pharmacotherapy or psychological
of interventions (psychological therapy plus

provision, which provide an alternative to

beyond the capacity of generic outpatient

component, individual CBT interventions, interpersonal psy-

therapies, other psychological therapies

chotherapy, and attachment-based family therapy [26,27]. A

systematic review evaluating suicide prevention programs tar-
geting indigenous youth (aboriginals) suggested that more
Evidence-based psychotherapies

inpatient mental health care

controlled study designs using planned evaluations and valid

outcome measures are needed in research on indigenous youth
suicide prevention [29].
treatment as usual
Intervention details

Community-based interventions
therapy

We report findings from six systematic reviews evaluating

various community-based interventions targeting adolescents
and youth; meta-analysis was conducted in two reviews.
AMSTAR ratings ranged between 4 and 7 with a median score of
Deenadayalan et al. [54]

5. Evidence from 20 studies evaluating community-based crea-

Shinohara et al. [51]

Shepperd et al. [53]

tive activities (including music, dance, singing, drama, and visual

Weisz et al. [52]

arts) suggests some positive effect on behavioral changes, self-

Cox et al. [50]

confidence, self-esteem, levels of knowledge, and physical ac-

Review

tivity [30]. The interventions used in the studies were diverse,

and the research was heterogeneous, and hence overall synthesis
of the results was not attempted. Another review based on 15
studies on community-based parent training and social skills
training for preventing depression suggested significant re-
Intervention

ductions in symptom and/or diagnostic measures at follow-up

Continued

[31]. However, meta-analysis was not conducted. Evidence

Table 2

from a review evaluating primary prevention mental health

trial.

programs for adolescents suggests that individually focused

S56 J.K. Das et al. / Journal of Adolescent Health 59 (2016) S49eS60

Table 3
Summary estimates for adolescent mental health interventions

Interventions Comparison Outcomes and estimates

(number of reviews)

School-based School-based CBT Symptoms of depression: effect size range: .21 to 1.40
interventions (n ¼ 12) CBT in secondary schools Depression (SMD: L.16; 95% CI: L.26 to L.05)
Anxiety (SMD: L.33; 95% CI: L.59 to L.06)
Classroom instructions Knowledge of suicide (SMD: 1.51; 95% CI: .57 to 2.45)
Knowledge of suicide prevention (SMD: .72; 95% CI: .36 to 1.07)
Community-based Person-centered programs Social acceptance at 3-month follow-up (SMD: .03; 95% CI: .10 to .04)
interventions (n ¼ 6) Affective education (SMD: .33; 95% CI: .18 to .48)
Aggregate of positive mental health outcome (SMD: .03; 95% CI: .19 to .25)
Person plus environment interventions Aggregate of positive mental health outcome (SMD: .27; 95% CI: .16 to .37)
Environment-only interventions Aggregate of positive mental health outcome (SMD: .38; 95% CI: .15 to .60)
Digital platforms (n ¼ 8) Mass media Discrimination: effect size range: SMD .85 to .17
Prejudice: effect size range: SMD 2.94 to 2.40
Individual-/family-based Media literacy and advocacy approach Internalization or acceptance of societal ideals relating to appearance
interventions (n ¼ 12) at a 3- to 6-month follow-up (SMD: L.28; 95% CI: L.51 to L.05)
Eating attitudes and behaviors and BMI at 12- to 14-month follow-up (SMD: .10; 95% CI: .45 to .25)
adolescent issues Eating Attitude Test at 6- to 12-month follow-up
(SMD: .01; 95% CI: .13 to .15)
Eating Disorder Inventory “bulimia” at 12- to 14-month
follow-up (SMD: .03; 95% CI: .16 to .10)
Self-esteem approach Close friendship at 3-month follow-up (SMD: .01; 95% CI: .09 to .06)
Exercise alone Self-esteem (SMD: .49; 95% CI: .16 to .81)
Exercise as a part of a comprehensive intervention Self-esteem (SMD: .51; 95% CI: .15 to .88)
Exercise compared to control Depression (SMD: L.62; 95% CI: L.81 to L.42)
Dropouts (RR: 1.00; 95% CI: .97 to 1.04)
Exercise compared to psychological therapies Depression (SMD: .03; 95%CI .32 to .26)
Exercise compared to antidepressant Depression (SMD: .11; 95% CI: .34 to .12)
Vigorous exercise versus no intervention Anxiety scores (SMD: .48; 95% CI: .97 to .01)
Depression score (SMD: L.66; 95% CI: L1.25 to L.08)
Vigorous exercise to low intensity exercise Anxiety scores (SMD: .14; 95% CI: .41 to .13)
Depression scores (SMD: .15; 95% CI: .44 to .14)
Exercise with psychosocial interventions Anxiety scores (SMD: .13; 95% CI: .43 to .17)
Depression scores (SMD: .10; 95% CI: .21 to .41)
Waitlist versus CBT for anxiety Anxiety remission (OR: 7.85; 95% CI: 5.31 to 11.6)
Participants lost to follow-up: (OR: .93; 95% CI: .58 to 1.51)
Psychological therapy versus antidepressant Remission (OR: .62; 95% CI: .28 to 1.35)
medications for depression Dropouts (OR: .61; 95% CI: .11 to 3.28)
Suicidal ideation (SMD: L3.12; 95% CI: L5.91 to L.33)
Depression symptoms (SMD: .16; 95% CI: .69 to 1.01)
Combination therapy versus antidepressant Remission (OR: 1.50; 95% CI: .99 to 2.27)
medication for depression Dropouts (OR: .84; 95% CI: .51 to 1.39)
Suicidal ideation (OR: .75; 95% CI: .26 to 2.16)
Depression symptoms (SMD: .27; 95% CI: 4.95 to 4.41)
Functioning (SMD: .09; 95% CI: .11 to .28)
Combination therapy versus psychological therapy Remission (OR: 1.61; 95% CI: .38 to 6.90)
Dropouts (OR: 1.23; 95% CI: .12 to 12.71)
Suicidal ideation (SMD: .60; 95% CI: 2.25 to 3.45)
Depression symptoms (SMD: .28; 95% CI: 1.41 to .84)
Combination therapy versus psychological Dropouts (OR: .98; 95% CI: .42 to 2.28)
therapy plus placebo Remission (OR: 2.15; 95% CI: 1.15 to 4.02)
Depression symptoms (SMD: L.52; 95% CI: L.78 to L.26)
Antidepressants compared to placebo to Number of relapsed recurred (OR: .34; 95% CI: .18 to .64)
relapse and recurrence Suicide-related behaviors (OR: 1.02; 95% CI: .14 to 7.39)
Dropouts (OR: 1.02; 95% CI: .38 to 2.79)
Behavioral therapy compared to all other Response (RR: .97; 95% CI: .86 to 1.09)
psychological therapies Remission (RR: .91; 95% CI: .8 to 1.04)
Response at follow-up (RR: .77; 95% CI: .59 to 1.01)
Depression severity (SMD: .03; 95% CI: .2 to .15)
Dropouts (RR: 1.02; 95% CI: .65 to 1.61)
Evidence-based youth-focused psychotherapy Effect size (SMD: .31; 95% CI: .16 to .44)
versus usual clinical care
Evidence-based parent-/family-focused Effect size (SMD: .16; 95% CI: .01 to .33)
psychotherapy versus usual clinical care
Multisystem approaches Effect size (SMD: .35; 95% CI: .19 to .52)
Combinations Effect size (SMD: .29; 95% CI: .06 to .52)

Bold indicates significant impact. Italics indicate nonsignificant impact.

BMI ¼ body mass index; CBT, cognitive behavioral therapy; CI ¼ confidence interval; OR ¼ odds ratio; RR ¼ relative risk; SMD ¼ standard mean difference.
 J.K. Das et al. / Journal of Adolescent Health 59 (2016) S49eS60
mental health promotion efforts and attempts to help negotiate
stressful transitions yield significant mean effects on reducing
problems and increasing competencies [32]. Evidence from
community-based mental health delivery programs specifically
targeting mental health promotion of young people in LMICs
suggests positive impacts on mental health outcomes; however,
pooled analysis could not be conducted [19]. Another review
evaluating community-based mental health and behavioral
programs for low-income urban youth suggested that person-
only interventions had a nonsignificant impact on improving
mental health (measured by an aggregate outcome measure;
SMD: .03; 95% CI: .19 to .25) while person plus environmental
interventions (SMD: .27; 95% CI: .16e.37) and environment-only
interventions had a significant positive impact (SMD: .38; 95% CI:
.15e.60) [33]. One review reporting the impact of treatment of
adolescent mental health disorders in primary care settings
suggests some preliminary evidence that treatments by
specialist staff working in primary care were effective, although
quality of included studies was variable. Meta-analysis could not
be conducted. Some educational interventions showed potential
for increasing skills and confidence of primary care staff, but
controlled evaluations were rare, and few studies reported the
actual change in professional behavior or patient health out-
comes [34].
Digital platforms for mental health interventions
We report findings from eight systematic reviews evaluating
impact of digital platforms for mental health disorders. None of
the included reviews conducted meta-analysis. AMSTAR rating
ranged between 4 and 11 with a median score of 9. A review
evaluating the impact of mass media interventions from two
studies suggests an impact ranging from SMD .85 to .17 on
discrimination while the impact on prejudice ranged between
SMD 2.94 and 2.40. The studies were very heterogeneous,
statistically, in their populations, interventions, and outcomes,
and hence meta-analysis could not be conducted [35]. Evidence
pertaining to mass media suggests that mass mediaebased
behavioral treatments have a moderate effect while computer-
ized CBT for mental health suggests that such interventions are
cost-effective and often cheaper than usual care [36,37].
Another review evaluating online youth mental health promo-
tion and prevention interventions indicates that there is some
evidence that skills-based interventions presented in a module-
based format can have a significant impact on adolescent
mental health; however, an insufficient number of studies limit
this finding. The results from online interventions indicate sig-
nificant positive effect of computerized CBT on adolescents’ and
emerging adults’ anxiety and depression symptoms [38]. These
findings are based on 20 studies; however, meta-analysis could
not be conducted in this review due to heterogeneity in studies.
Evidence from four Internet-based prevention and treatment
programs for anxiety and depression suggests early support for
the effectiveness; however, more extensive and rigorous
research is warranted to further establish the conditions
through which effectiveness is enhanced, as well as to develop
additional programs to address gaps in the field [39]. Three
reviews evaluating the acceptability and feasibility of mental
health resources among youth suggested that young people
regularly use and are generally satisfied with online mental
health resources [40e42].
S57
Individual-/family-based interventions
We included 12 systematic reviews focusing on individual- or
family-based interventions, of which 10 reviews performed
meta-analysis. AMSTAR rating ranged between 6 and 11 with a
median score of 11. One review focused on interventions for
eating disorders; four reviews focused on physical activity and
exercise interventions; six reviews focused on CBT, psychother-
apy, behavioral, and pharmacological interventions for anxiety
and depression; while two reviews focused on home-based
multisystemic interventions.
A systematic review on the effectiveness of eating disorder
programs for adolescents focused on eating disorder awareness,
healthy eating attitudes and behaviors, media literacy and
advocacy skills, and promoting self-esteem [43]. All included
studies were conducted in high-income countries (HICs). In-
terventions focusing on eating attitudes and behaviors showed
no impact on body mass index at 12- to 14-month follow-up
(SMD: .10; 95% CI: .45 to .25), Eating Attitude Test at 6- to
12-month follow-up (SMD: .01; 95% CI: .13 to .15), and bulimia
at 12- to 14-month follow-up (SMD: .03; 95% CI: .16 to .10).
Combined data from two eating disorder prevention programs
based on a media literacy and advocacy approach showed a
significant reduction in the internalization or acceptance of
societal ideals relating to appearance at a 3- to 6-month follow-
up (SMD: .28; 95% CI: .51 to .05). Two studies focusing on
self-esteem approach showed no impact on close friendships
(SMD: .01; 95% CI: .09 to .06) and social acceptance
(SMD: .03; 95% CI: .10, .04) at 3-month follow-up. There is not
enough evidence to suggest any harm from any of the prevention
programs included in the review.
Four systematic reviews evaluated the impact of exercise and
physical activity on mental health outcomes among adolescents
and youth. Exercise alone was evaluated in eight studies showing
significant impact on self-esteem (SMD: .49; 95% CI: .16e.81).
Exercise as a part of other comprehensive interventions was
evaluated in four studies and showed a significant improvement
in self-esteem (SMD: .51; 95% CI: .15e.88). However, these con-
clusions are based on several small number of trials reporting
poolable data with lack of long-term follow-up data [44].
Another review reporting the effects of physical activity pro-
grams (including outdoor adventure, sport and skill-based and
physical fitness program) included 15 studies. Due to small
number of studies and large heterogeneity in terms of study
length, sample size, assessment of outcomes, and participants,
meta-analysis was not conducted. Some studies suggested pos-
itive impacts on social and emotional well-being; however, due
to mixed findings and the high risk of bias, the efficacy of physical
activity programs could not be concluded [45]. Evidence on the
use of exercise for depression compared to no treatment suggests
significant impact in reducing depression from 35 trials
(SMD: .62; 95% CI: .81 to .42) while there was no impact on
dropouts (relative risk [RR]: 1.00; 95% CI: .97e1.04). Exercise
when compared to psychological therapy and pharmacological
treatment found no significant difference on depression
(SMD .03; 95% CI: .32 to .26 and SMD: .11; 95% CI: .34 to
.12, respectively) [46]. Vigorous exercise when compared to no
intervention led to reduced depression score (SMD: .66; 95%
CI: 1.25, .08) with no impact on anxiety scores (SMD: .48;
95% CI: .97, .01) while vigorous exercise when compared to low
intensity exercise and psychosocial interventions showed com-
parable results. However, the small number of studies and the
S58 J.K. Das et al. / Journal of Adolescent Health 59 (2016) S49eS60
clinical diversity of participants, interventions, and methods of
measurement limit the ability to draw conclusions [47].
Six systematic reviews reported findings on interventions for
anxiety and depression among adolescents and youth. A review
on the effectiveness of CBT for anxiety disorders included
41 studies. CBT compared to waitlist was effective in reducing
remission (odds ratio [OR]: 7.85; 95% CI: 5.31e11.6). There was
nonsignificant impact on participants lost to follow-up (OR: .93;
95% CI: .58e1.51) [48]. A review evaluating the impact of psy-
chological therapies and antidepressant medication, alone and
in combination, for the treatment of depressive disorder for
adolescents included 11 studies. Findings suggest that psycho-
logical therapy when compared to antidepressants had com-
parable effect on remission (OR: .62; 95% CI: .28e1.35), dropouts
(OR: .61; 95% CI: .11e3.28), and depression symptoms (SMD: .16;
95% CI: .69 to 1.01) while psychological therapy significantly
reduced suicidal ideation (SMD: 3.12, 95% CI: 5.91 to .33)
when compared to antidepressant. Combination therapy was
also found to be comparable to antidepressant medications for
remission (OR: 1.50; 95% CI: .99e2.27), dropouts (OR: .84; 95%
CI: .51e1.39), suicidal ideation (OR: .75; 95% CI: .26e2.16),
depression symptoms (SMD: .27; 95% CI: 4.95 to 4.41), and
functioning (SMD: .09; 95% CI: .11 to .28). Combination ther-
apy was also found to be comparable to psychological therapy
for remission (OR: 1.61; 95% CI: .38e6.90), dropouts (OR: 1.23;
95% CI: .12e12.71), suicidal ideation (SMD: .60; 95% CI: 2.25 to
3.45), and depression symptoms (SMD: .28; 95% CI: 1.41 to
.84). Psychological therapy when compared to combination
therapy was effective in reducing remission (OR: 2.15; 95%
CI: 1.15e4.02). Combination therapy significantly reduced
depression symptoms (SMD: .52; 95% CI: .78 to .26)
compared to psychological therapy plus placebo [49]. Another
review evaluating the impact of interventions for relapse and
recurrence of depressive disorders included nine trials. Findings
suggest reduction in number of relapsed recurred (OR: .34; 95%
CI: .18e.64) with no impact on suicide-related behaviors (OR:
1.02; 95% CI: .14e7.39) and dropouts (1.02; 95% CI: .38e2.79)
[50]. However, there is considerable diversity in the design of
trials, making it difficult to compare outcomes across studies
[50]. Behavioral therapy when compared to all other psycho-
logical therapies is reported to be equally effective for depres-
sion response (RR: .97; 95% CI: .86e1.09); remission (RR: .91;
95% CI: .8e1.04); response at follow-up (RR: .77; 95% CI:
.59e1.01); depression severity (SMD: .03; 95% CI: .2e.15);
and dropout (RR: 1.02; 95% CI: .65e1.61) [51]. Another review
evaluating the performance of evidence-based youth psycho-
therapies compared with usual clinical care suggests that psy-
chotherapies outperform usual care (SMD: .31; 95% CI: .16e.44),
but the advantage is modest and moderated by youth, location,
and assessment characteristics [52].
Evidence suggests that home-based multisystemic therapy
resulted in improved externalizing symptoms, and they spent
fewer days out-of-school and out-of-home placement. Intensive
home-based crisis intervention using the “Homebuilders” model
(components include relationship building, reframing problems,
anger management, communication, setting treatment goals,
and CBT) did not show any impact when compared to routine
inpatient care [53]. Day therapy programs for adolescents with
mental health disorders (including anxiety disorders, social
phobia, and behavioral issues) suggest that it may be an effective
intervention for adolescents with mental health disorders. A
multimodal and multidisciplinary group-based treatment
approach has shown to be most effective, and participants could
benefit from the involvement of at least one health professional
from a psychology or psychiatric background. Further high-level,
high-quality research using standardized outcome measures is
required to support these findings and determine key parame-
ters, such as an optimal frequency and duration for day therapy
programs [54].
Discussion
We report findings from a total of 38 systematic reviews with
an AMSTAR rating ranging between 7 and 11 and a median score
of 8. Evidence from school-based interventions suggests that
targeted group-based interventions and CBT were found to be
effective in reducing depressive symptoms and anxiety. School-
based suicide prevention programs suggest that classroom-
based didactic and experiential programs increased short-term
knowledge of suicide and knowledge of suicide prevention
with no evidence of an effect on suicide-related attitudes or
behaviors. Community-based creative activities had some posi-
tive effect on behavioral changes, self-confidence, self-esteem,
levels of knowledge, and physical activity. Evidence from digital
platforms supports Internet-based prevention and treatment
programs for anxiety and depression; however, more extensive
and rigorous research is warranted to further establish the con-
ditions. Among individual- and family-based interventions,
interventions focusing on eating attitudes and behaviors showed
no impact on body mass index, Eating Attitude Test, and bulimia.
Exercise was found to be effective in improving self-esteem and
reduced depression score with no impact on anxiety scores. CBT
compared to waitlist was effective in reducing remission. Psy-
chological therapy when compared to antidepressants had
comparable effect on remission, dropouts, and depression
symptoms. Most of the evidence is from HICs, limiting the
generalizability of the findings for LMICs. Meta-analysis could
not be conducted in many of the included reviews due to het-
erogeneity in their populations, interventions, and outcomes.
One of the limitations of our review was that the scope of our
review was limited to interventions targeting adolescents and
youth only; however, mental health interventions take a life
course perspective. Mental health disorders are linked in
different ways and levels, exerting a dimensional effect between
environmental, genetic factors and other biological mechanisms
[55e57]. Evidence from recent literature suggests interventions
to support parenting offer much scope for improving mental
health among children and adolescents later in life [58e62].
Evidence suggests that early childhood development (ECD)
interventions including stimulation in early childhood, preschool
level interventions, and ECD consultations have shown to be
effective in improving health behaviors, conduct problems, and
social skills and are also low-cost interventions delivered in
home and at school [63e67]. Evidence also suggests that ECD
and parenting interventions can be implemented effectively in
LMICs’ schools and community settings; however, evidence for
scaling-up and sustainability of mental health promotion in-
terventions in LMICs needs to be strengthened [68].
There are challenges pertaining to adolescent mental health
due to the associated stigma. Furthermore, there are gaps related
to monitoring the health behavior of adolescents, even with
multicountry surveys, for example, most of the data are gathered
among older adolescents. More widespread developmentally
appropriate surveys of younger adolescents may help identify
 J.K. Das et al. / Journal of Adolescent Health 59 (2016) S49eS60
key ages for implementing preventive mental health in-
terventions. Most population-based adolescent health surveys
are conducted in schools. However, even in HICs, there are
adolescents who are not in school and who may face significant
health inequities. Furthermore, there is little consensus on which
indicators and protective factors are the best survey measures.
Findings from our review highlight that the existing evidence on
mental health interventions for adolescents comes mainly from
HICs. There is lack of standardized interventions and outcomes
due to which meta-analysis could not be conducted in most of
the included systematic reviews. Long-term follow-up data were
not available since most of the studies reported outcomes at
short-term follow-up, and hence the extent to which the effects
of programs were maintained over longer periods of time could
not be evaluated. There is a dire need for rigorous, high-quality
evidence especially from LMICs on effective interventions to
prevent and manage mental health disorders among adoles-
cents. Future trials should also focus on standardized in-
terventions and outcomes for synthesizing the exiting body of
knowledge. There is a need to report differential effects for
gender, age groups, socioeconomic status, and geographic set-
tings since the impact of mental health interventions might vary
according to various contextual factors. Availability of such data
would help investigate if certain strategies are more beneficial
for one group over the other and developing targeted strategies
for various subgroups to optimize effectiveness of interventions.
Acknowledgments
All authors contributed to finalizing the manuscript.
Funding Sources
The preparation and publication of these papers was made
possible through an unrestricted grant from the Bill & Melinda
Gates Foundation (BMGF). V.P. is supported by a Wellcome Trust
Principal Research Fellowship in Clinical Science.
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APLIKASIA: Jurnal Aplikasi Ilmu-ilmu Agama ISSN 1411-8777
Volume 17, Nomor 1, 2017 | Page: 25-32 ONLINE: ejournal.uin-suka.ac.id/pusat/aplikasia

Memahami Ciri dan Tugas Perkembangan Masa Remaja

Khamim Zarkasih Putro
Fakultas Ilmu Tarbiyah dan Keguruan (FITK) Universitas Islam Negeri Sunan Kalijaga, Indonesia
Email: khamim.putro@uin-suka.ac.id

Abstrak. Masa remaja berada pada batas peralihan kehidupan anak dan dewasa. Tubuhnya tampak sudah
“dewasa”, akan tetapi bila diperlakukan seperti orang dewasa remaja gagal menunjukan kedewasaannya.
Pengalamannya mengenai alam dewasa masih belum banyak karena ia sering terlihat pada remaja adanya
kegelisahan, pertentangan, kebingungan, dan konflik pada diri sendiri. Bagaimana remaja memandang
peristiwa yang dialami akan menentukan perilakunya dalam menghadapi peristiwa-peristiwa tersebut.
Kata kunci: remaja, perkembangan masa remaja

A. Pengertian Remaja
Tidak mudah untuk mendefinisikan remaja secara tepat, karena banyak sekali sudut pandang yang
dapat digunakan dalam mendefinisikan remaja. Kata “remaja” berasal dari bahasa Latin adolescene berarti
to grow atau to grow maturity (Golinko, 1984, Rice, 1990 dalam Jahja, 2011).1 Banyak tokoh yang memberikan
definisi remaja, seperti DeBrun mendefinisikan remaja sebagai periode pertumbuhan antara masa kanak-
kanak dan dewasa.2
Papalia dan Olds3 tidak memberikan pengertian remaja secara eksplisit melainkan secara implisit
melalui pengertian masa remaja (adolescence). Menurut Papalia dan Olds,4 masa remaja adalah masa transisi
perkembangan antara masa kanak-kanak dan dewasa yang pada umumnya dimulai pada usia 12 atau 13
tahun dan berakhir pada usia akhir belasan tahun atau awal dua puluh tahun. Sedangkan Anna Freud,5
berpendapat bahwa pada masa remaja terjadi proses perkembangan meliputi perubahan-perubahan yang
berhubungan dengan perkembangan psikoseksual, dan juga terjadi perubahan dalam hubungan dengan
orangtua dan cita-cita mereka, di mana pembentukan cita-cita merupakan proses pembentukan orientasi
masa depan.
Badan Kesehatan Dunia (WHO) memberikan batasan mengenai siapa remaja secara konseptual.
Dikemukakannya oleh WHO ada tiga kriteria yang digunakan; biologis, psikologis, dan sosial ekonomi,
yakni: (1) individu yang berkembang saat pertama kali ia menunjukkan tanda-tanda seksual sekundernya
sampai saat ia mencapai kematangan seksual, (2) individu yang mengalami perkembangan psikologis dan
pola identifikasi dari anak-anak menjadi dewasa, dan (3) terjadi peralihan dari ketergantungan sosial
ekonomi yang penuh kepada keadaan yang lebih mandiri.6

1 Yudrik Jahja, Psikologi Perkembangan, (Jakarta:Kencana, 2011), hlm. 219

2 Ibid., . hlm. 220.
3 Ibid
4 Ibid
5 Ibid
6 S. Wirawan, Psikologi Remaja, (Jakarta: Raja Grafindo Persada, 2002), hlm. 23
Khamim Zarkasih Putro

Selanjutnya, Wirawan7 menjelaskan bahwa untuk mendefinisikan remaja seharusnya disesuaikan

dengan budaya setempat, sehingga untuk di Indonesia digunakan batasan usia 11-24 tahun dan belum
menikah dengan pertimbangan-pertimbangan sebagai berikut :
1. Usia 11 tahun adalah usia di mana pada umumnya tanda-tanda sekunder mulai nampak.
2. Pada masyarakat Indonesia, usia 11 tahun sudah dianggap akil baligh, baik menurut adat maupun agama,
sehingga masyarakat tidak lagi memperlakukan mereka sebagai anak-anak.
3. Pada usia tersebut mulai ada tanda-tanda penyempurnaan perkembangan jiwa seperti tercapainya
identitas ego (menurut Ericson), tercapainya fase genital dari perkembangan psikoseksual (menurut
Freud), dan tercapainya puncak perkembangan kognitif (menurut Piaget), maupun moral (menurut
Kohlberg).
4. Batas usia 24 tahun adalah merupakan batas maksimal, yaitu untuk memberi peluang bagi mereka yang
sampai batas usia tersebut masih menggantungkan diri pada orangtua, belum mempunyai hak-hak
penuh sebagai orangtua.
5. Dalam definisi tersebut, status perkawinan sangat menentukan apakah individu masih digolongkan
sebagai remaja ataukah tidak.

B. Ciri-ciri Remaja
Seperti halnya pada semua periode yang penting, sela rentang kehidupan masa remaja mempunyai
ciri-ciri tertentu yang membedakannya dengan periode sebelumnya dan sesudahnya. Masa remaja ini, selalu
merupakan masa-masa sulit bagi remaja maupun orangtuanya. Menurut Sidik Jatmika,8 kesulitan itu
berangkat dari fenomena remaja sendiri dengan beberapa perilaku khusus; yakni:
1. Remaja mulai menyampaikan kebebasannya dan haknya untuk mengemukakan pendapatnya sendiri.
Tidak terhindarkan, ini dapat menciptakan ketegangan dan perselisihan, dan bias menjauhkan remaja
dari keluarganya.
2. Remaja lebih mudah dipengaruhi oleh teman-temannya daripada ketika mereka masih kanak-kanak. Ini
berarti bahwa pengaruh orangtua semakin lemah. Anak remaja berperilaku dan mempunyai kesenangan
yang berbeda bahkan bertentangan dengan perilaku dan kesenangan keluarga. Contoh-contoh yang
umum adalah dalam hal mode pakaian, potongan rambut, kesenangan musik yang kesemuanya harus
mutakhir.
3. Remaja mengalami perubahan fisik yang luar biasa, baik pertumbuhannya maupun seksualitasnya.
Perasaan seksual yang mulai muncul bisa menakutkan, membingungkan dan menjadi sumber perasaan
salah dan frustrasi.
4. Remaja sering menjadi terlalu percaya diri (over confidence) dan ini bersama-sama dengan emosinya yang
biasanya meningkat, mengakibatkan sulit menerima nasihat dan pengarahan oangtua.
Selanjutnya, Sidik Jatmika,9 menjelaskan adanya kesulitan yang sering dialami kaum remaja yang
betapapun menjemukan bagi mereka dan orangtua, medrupakan bagian yang normal dari perkembangan
remaja itu sendiri. Beberapa kesulitan atau bahaya yang mungkin dialami kaum remaja antara lain:
1. Variasi kondisi kejiwaan. Suatu saat mungkin ia terlihat pendiam, cemberut, dan mengasingkan diri,
tetapi pada saat yang lain terlihat sebaliknya, periang, berseri-seri dan yakin. Perilaku yang sulit ditebak
dan berubah-ubah ini bukanlah sesuatu yang abnormal.hal ini hanyalah perlu diprihatinkan dan
menjadi kewaspadaan bersama manakala telah menjerumuskan remaja dalam kesulitan-kesulitan di
sekolah atau kesulitan dengan teman-temannya.

7 Ibid
8 Sidik Jatmika, Genk Remaja, Anak Haram Sejarah ataukah Korban Globalisasi?,(Yogyakarta:Kanisius, 2010), hlm.10-
11.
9 Ibid, hlm.11-12

26 APLIKASIA: Jurnal Aplikasi Ilmu-ilmu Agama, Vol. 17, No. 1, 2017

 Memahami Ciri dan Tugas Perkembangan Masa Remaja

2. Rasa ingin tahu seksual dan coba-coba. Hal ini merupakan sesuatu yang normal dan sehat. Rasa ingin
tahu seksual dan bangkitnya rasa birahi adalah normal dan sehat. Ingat, perilaku tertarik pada seks
sendiri juga merupakan cirri yang normal pada perkembangan masa remaja. Rasa ingin tahu seksual dan
birahi jelas menimbulkan bentuk-bentuk perilaku seksual.
3. Membolos.
4. Perilaku anti sosial, seperti suka mengganggu, berbohong, kejam dan menunjukkan perilaku agresif.
Sebabnya mungkin bermacam-macam dan banyak tergantung pada budayanya. Akan tetapi, penyebab
yang mendasar adalah pengaruh buruk teman, dan pendisiplinan yang salah dari orangtua, terutama bila
terlalu keras atau terlalu lunak – dan sering tidak ada sama sekali.
5. Penyalahgunaan obat bius.
6. Psikosis, bentuk psikosis yang paling dikenal orang adalah skizofrenia (setengah gila hingga gila
beneran).
Dari berbagai penjelasan di atas, dapatlah dipahami tentang berbagai ciri yang menjadi kekhususan
remaja. Ciri-ciri tersebut adalah :10
1. Masa remaja sebagai periode yang penting
Pada periode remaja, baik akibat langsung maupun akibat jangka panjang tetaplah penting.
Perkembangan fisik yang begitu cepat disertai dengan cepatnya perkembangan mental, terutama pada
masa awal remaja. Semua perkembangan ini menimbulkan perlunya penyesuaian mental serta perlunya
membentuk sikap, nilai, dan minat baru.
2. Masa remaja sebagai periode peralihan
Pada fase ini, remaja bukan lagi seorang anak dan bukan juga orang dewasa. Kalau remaja berperilaku
seperti anak-anak, ia akan diajari untuk bertindak sesuai dengan umurnya. Kalau remaja berusaha
berperilaku sebagaimana orang dewasa, remaja seringkali dituduh terlalu besar ukurannya dan dimarahi
karena mencoba bertindak seperti orang dewasa. Di lain pihak, status remaja yang tidak jelas ini juga
menguntungkan karena status memberi waktu kepadanya untuk mencoba gaya hidup yang berbeda dan
menentukan pola perilaku, nilai, dan sifat yang paling sesuai bagi dirinya.
3. Masa remaja sebagai periode perubahan
Tingkat perubahan dalam sikap dan perilaku selama masa remaja sejajar dengan tingkat perubahan fisik.
Selama awal masa remaja, ketika perubahan fisik terjadi dengan pesat, perubahan perilaku dan sikap juga
berlangsung pesat. Kalau perubahan fisik menurun, maka perubahan sikap dan perilaku juga menurun.
4. Masa remaja sebagai usia bermasalah
Setiap periode perkembangan mempunyai masalahnya sendiri-sendiri, namun masalah masa remaja
sering menjadi persoalan yang sulit diatasi baik oleh anak laki-laki maupun anak perempuan.
Ketidakmampuan mereka untuk mengatasi sendiri masalahnya menurut cara yang mereka yakini,
banyak remaja akhirnya menemukan bahwa penyelesaiannya tidak selalu sesuai dengan harapan mereka.
5. Masa remaja sebagai masa mencari identitas
Pada tahun-tahun awal masa remaja, penyesuaian diri terhadap kelompok masih tetap penting bagi anak
laki-laki dan perempuan. Lambat laun mereka mulai mendambakan identitas diri dan tidak puas lagi
dengan menjadi sama dengan teman-teman dalam segala hal, seperti sebelumnya. Status remaja yang
mendua ini menimbulkan suatu dilema yang menyebabkan remaja mengalami “krisis identitas” atau
masalah-masalah identitas-ego pada remaja.
6. Masa remaja sebagai usia yang menimbulkan ketakutan
Anggapan stereotip budaya bahwa remaja suka berbuat semaunya sendiri atau “semau gue”, yang tidak
dapat dipercaya dan cenderung berperilaku merusak, menyebabkan orang dewasa yang harus

10 Hurlock, E.B., Psikologi Perkembangan: Suatu Pendekatan Sepanjang Rentang Kehidupan, (Jakarta:Erlangga, 1993)
hlm. 221

APLIKASIA: Jurnal Aplikasi Ilmu-ilmu Agama, Vol. 17, No. 1, 2017 27

Khamim Zarkasih Putro

membimbing dan mengawasi kehidupan remaja yang takut bertanggung jawab dan bersikap tidak
simpatik terhadap perilaku remaja yang normal.
7. Masa remaja sebagai masa yang tidak realistik
Masa remaja cenderung memandang kehidupan melalui kacamata berwarna merah jambu. Ia melihat
dirinya sendiri dan orang lain sebagaimana yang ia inginkan dan bukan sebagaimana adanya, terlebih
dalam hal harapan dan cita-cita. Harapan dan cita-cita yang tidak realistik ini, tidak hanya bagi dirinya
sendiri tetapi juga bagi keluarga dan teman-temannya, menyebabkan meningginya emosi yang
merupakan ciri dari awal masa remaja. Remaja akan sakit hati dan kecewa apabila orang lain
mengecewakannya atau kalau ia tidak berhasil mencapai tujuan yang telah ditetapkannya sendiri.
8. Masa remaja sebagai ambang masa dewasa
Semakin mendekatnya usia kematangan yang sah, para remaja menjadi gelisah untuk meninggalkan
stereotip belasan tahun dan untuk memberikan kesan bahwa mereka sudah hampir dewasa. Berpakaian
dan bertindak seperti orang dewasa ternyata belumlah cukup. Oleh karena itu, remaja mulai
memusatkan diri pada perilaku yang dihubungkan dengan status dewasa, yaitu merokok, minum-
minuman keras, menggunakan obat-obatan, dan terlibat dalam perbuatan seks bebas yang cukup
meresahkan. Mereka menganggap bahwa perilaku yang seperti ini akan memberikan citra yang sesuai
dengan yang diharapkan mereka.
Selanjutnya, Jahja11 mengemukakan bahwa masa remaja adalah suatu masa perubahan. Pada masa
remaja terjadi perubahan yang cepat baik secra fisik, maupun psikologis. Ada beberapa perubahan yang
terjadi selama masa remaja yang sekaligus sebagai ciri-ciri masa remaja yaitu :
1. Peningkatan emosional yang terjadi secara cepat pada masa remaja awal yang dikenal sebagai masa storm
& stress. Peningkatan emosional ini merupakan hasil dari perubahan fisik terutama hormon yang terjadi
pada masa remaja. Dari segi kondisi sosial, peningkatan emosi ini merupakan tanda bahwa remaja berada
dalam kondisi bari yang berbeda dari masa-masa yang sebelumnya. Pada fase ini banyak tuntutan dan
tekanan yang ditujukan kepada remaja, misalnya mereka diharapkan untuk tidak lagi bertingkah laku
seperti anak-anak, mereka harus lebih mandiri, dan bertanggung jawab. Kemandirian dan tanggung
jawab ini akan terbentuk seiring berjalannya waktu, dan akan tampak jelas pada remaja akhir yang duduk
di awal-awal masa kuliah di Perguruan Tinggi.
2. Perubahan yang cepat secara fisik juga disertai dengan kematangan seksual. Terkadang perubahan ini
membuat remaja merasa tidak yakin akan diri dan kemampuan mereka sendiri. Perubahan fisik yang
terjadi secara cepat, baik perubahan internal seperti sistem sirkulasi, pencernaan, dan sistem respirasi
maupun perubahan eksternal seperti tinggi badan, berat badan, dan proporsi tubuh sangat berpengaruh
terhadap konsep diri remaja.
3. Perubahan dalam hal yang menarik bagi dirinya dan hubungannya dengan orang lain. Selama masa
remaja banyak hal-hal yang menarik bagi dirinya dibawa dari masa kanak-kanak digantikan dengan hal
menarik yang baru dan lebih matang. Hal ini juga dikarenakan adanya tanggung jawab yang lebih besar
pada masa remaja, maka remaja diharapkan untuk dapat mengarahkan ketertarikan mereka pada hal-hal
yang lebih penting. Perubahan juga terjadi dalam hubungannya dengan orang lain. Remaja tidak lagi
berhubungan hanya dengan individu dari jenis kelamin yang sama, tetapi juga dengan lawan jenis, dan
dengan orang dewasa.
4. Perubahan nilai, di mana apa yang mereka anggap penting pada masa kanak-kanak menjadi kurang
penting, karena telah mendekati dewasa.
5. Kebanyakan remaja bersikap ambivalen dalam menghadapi perubahan yang terjadi. Di satu sisi mereka
menginginkan kebebasan, tetapi di sisi lain mereka takut akan tanggung jawab yang menyertai
kebebasan itu, serta meragukan kemampuan mereka sendiri untuk memikul tanggung jawab itu.

11 Yudrik Jahja, Psikologi Perkembangan,hlm. 238

28 APLIKASIA: Jurnal Aplikasi Ilmu-ilmu Agama, Vol. 17, No. 1, 2017

 Memahami Ciri dan Tugas Perkembangan Masa Remaja

Selanjutnya dilengkapi pula oleh Gunarsa & Gunarsa,12 dan Mappiare,13 dalam menjelaskan ciri-ciri
remaja sebagai berikut :
1. Masa remaja awal. Biasanya duduk di bangku Sekolah Menengah Pertama, dengan ciri-ciri: (1) tidak
stabil keadaannya, lebih emosional, (2) mempunyai banyak masalah, (3) masa yang kritis, (4) mulai
tertarik pada lawan jenis, (5) munculnya rasa kurang percaya diri, dan (6) suka mengembangkan pikiran
baru, gelisah, suka berkhayal dan suka menyendiri.
2. Masa remaja madya (pertengahan). Biasanya duduk di bangku Sekolah Menengah Atas dengan ciri-ciri:
(1) sangat membutuhkan teman, (2) cenderung bersifat narsistik/kecintaan pada diri sendiri, (3) berada
dalam kondisi keresahan dan kebingungan, karena pertentangan yang terjadi dalam diri, (4) berkenginan
besar mencoba segala hal yang belum diketahuinya, dan (5) keinginan menjelajah ke alam sekitar yang
lebih luas.
3. Masa remaja akhir. Ditandai dengan ciri-ciri: (1) aspek-aspek psikis dan fisiknya mulai stabil, (2)
meningkatnya berfikir realistis, memiliki sikap pandang yang sudah baik, (3) lebih matang dalam cara
menghadapi masalah, (4) ketenangan emosional bertambah, lebih mampu menguasai perasaan, (5)
sudah terbentuk identitas seksual yang tidak akan berubah lagi, dan (6) lebih banyak perhatian terhadap
lamabang-lambang kematangan.
Berdasarkan pendapat para ahli yang telah dikemukakan dapatlah disimpulkan bahwa masa remaja
berada pada batas peralihan kehidupan anak dan dewasa. Tubuhnya tampak sudah “dewasa”, akan tetapi
bila diperlakukan seperti orang dewasa remaja gagal menunjukan kedewasaannya. Pengalamannya
mengenai alam dewasa masih belum banyak karena ia sering terlihat pada remaja adanya kegelisahan,
pertentangan, kebingungan, dan konflik pada diri sendiri. Bagaimana remaja memandang peristiwa yang
dialami akan menentukan perilakunya dalam menghadapi peristiwa-peristiwa tersebut.

C. Tugas-tugas Perkembangan Masa Remaja

Salah satu periode dalam rentang kehidupan ialah (fase) remaja. Masa ini merupakan segmen
kehidupan yang penting dalam siklus perkembangan individu, dan merupakan masa transisi yang dapat
diarahkan kepada perkembangan masa dewasa yang sehat. Untuk dapat melakukan sosialisasi dengan baik,
remaja harus menjalankan tugas-tugas perkembangan pada usinya dengan baik.
Apabila tugas pekembangan sosial ini dapat dilakukan dengan baik, remaja tidak akan mengalami
kesulitan dalam kehidupan sosialnya serta akan membawa kebahagiaan dan kesuksesan dalam
menuntaskan tugas perkembangan untuk fase-fase berikutnya. Sebaliknya, manakala remaja gagal
menjalankan tugas-tugas perkembangannya akan membawa akibat negatif dalam kehidupan sosial fase-fase
berikutnya, menyebabkan ketidakbahagiaan pada remaja yang bersangkutan, menimbulkan penolakan
masyarakat, dan kesulitan-kesulitan dalam menuntaskan tugas-tugas perkembangan berikutnya.
William Kay, sebagaimana dikutip Yudrik Jahja14 mengemukakan tugas-tugas perkembangan masa
remaja sebagai berikut:
1. Menerima fisiknya sendiri berikut keragaman kualitasnya.
2. Mencapai kemandirian emosional dari orangtua atau figur-figur yang mempunyai otoritas.
3. Mengembangkan ketrampilan komunikasi interpersonal dan bergaul dengan teman sebaya, baik secara
individual maupun kelompok.
4. Menemukan manusia model yang dijadikan identitas pribadinya.
5. Menerima dirinya sendiri dan memiliki kepercayaan terhadap kemampuannya sendiri.

12 Gunarsa, S.D., dan Gunarsa, Y.S., Psikologi Praktis: Anak, Remaja dan Keluarga, (Jakarta: BPK Gunung Mulia, 2001),
hlm. 77.
13 Mappiare, A., Psikologi Remaja, (Surabaya: Bina Usaha, 2000), hlm. 76.
14 Yudrik Jahja, Psikologi Perkembangan, hlm. 238

APLIKASIA: Jurnal Aplikasi Ilmu-ilmu Agama, Vol. 17, No. 1, 2017 29

Khamim Zarkasih Putro

6. Memeperkuat self-control (kemampuan mengendalikan diri) atas dasar skala nilai, prinsip-prinsip, atau
falsafah hidup (weltanschauung).
7. Mampu meninggalkan reaksi dan penyesuaian diri (sikap/perilaku) kekanak-kanakan.
Selanjutnya, dalam membahas tujuan tugas perkembangan remaja, Jahja15 mengemukakan pendapat
Luella Cole yang mengklasifikasikannya ke dalam sembilan kategori, yaitu:
1. Kematangan emosional. 4. Emansipasi dari control 7. Menggunakan waktu
2. Pemantapan minat-minat keluarga. senggang secara tepat.
heteroseksual. 5. Kematangan intelektual. 8. Memiliki falsafah hidup.
3. Kematangan sosial. 6. Memilih pekerjaan. 9. Identifikasi diri.

Secara rinci, Cole16 kemudian memerinci klasifikasi tersebut dalam suatu tabel berikut ini (Tabel 1.).
Tabel 1. Tujuan Perkembangan Masa Remaja17.

Dari arah Ke arah

Kematangan emosional
Tidak toleran dan bersikap superior. Bersikap toleran dan merasa nyaman.
Kaku dalam bergaul Luwes dalam bergaul.
Peniruan buta terhadap teman sebaya. Interdependensi dan mempunyai self-esteem.
Kontrol orangtua. Kontrol diri sendiri.
Perasaan yang tidak jelas tentang dirinya/orang lain. Perasaan mau menerima dirinya dan orang lain.
Kurang dapat mengendalikan diri dari rasa marah Mampu menyatakan emosinya secara konstruktif dan
dan sikap permusuhannya. kreatif.
Perkembangan heteroseksualitas
Belum memiliki kesadaran tentang perubahan Menerima identitas seksualnya sebagai pria atau wanita.
seksualnya.
Mengidentifikasi orang lain yang sama jenis Mempunyai perhatian terhadap jenis kelamin yang berbeda
kelaminnya. dan bergaul dengannya.
Bergaul dengan banyak teman. Memilih teman-teman tertentu.
Kematangan kognitif
Menyenangi prinsip-prinsip umum dan jawaban Membutuhkan penjelasan tentang fakta dan teori.
yang final.
Menerima kebenaran dari sumber otoritas. Memerlukan bukti sebelum menerima.
Memiliki banyak minat atau perhatian. Memiliki sedikit minat/perhatian terhadap jenis kelamin
yang berbeda dan bergaul dengannya.
Bersikap subjektif dalam menafsir sesuatu. Bersikap objektif dalam menafsirkan sesuatu.
Filsafat hidup
Tingkah laku dimotivasi oleh kesenangan belaka. Tingkah laku dimotivasi oleh aspirasi.
Acuh tak acuh terhadap prinsip-prinsip ideologi dan Melibatkan diri atau mempunyai perhatian terhadap
etika. ideologi dan etika.
Tingkah lakunya tergantung pada reintorcement Tingkah lakunya dibimbing oleh tanggung jawab moral.
(dorongan dari luar).

15 Ibid, hlm. 238-239

16 Ibid
17 Ibid, hlm. 239.

30 APLIKASIA: Jurnal Aplikasi Ilmu-ilmu Agama, Vol. 17, No. 1, 2017

 Memahami Ciri dan Tugas Perkembangan Masa Remaja

Tugas-tugas perkembangan masa remaja menurut Havighurst sebagaimana dikutip Gunarsa18,

sebagai berikut:
1. Menerima kenyataan terjadinya perubahan fisik yang dialaminya dan dapat melakukan peran sesuai
dengan jenisnya secara efektif dan merasa puas terhadap keadaan tersebut.
2. Belajar memiliki peranan sosial dengan teman sebaya, baik teman sejenis maupun lawan jenis sesuai
dengan jenis kelamin masing-masing.
3. Mencapai kebebasan dari ketergantungan terhadap orangtua dan orang dewasa lainnya.
4. Mengembangkan kecakapan intelektual dan konsep-konsep tentang kehidupan bermasyarakat.
5. Mencari jaminan bahwa suatu saat harus mampu berdiri sendiri dalam bidang ekonomi guna mencapai
kebebasan ekonomi.
6. Mempersiapkan diri untuk menentukan suatu pekerjaan yang sesuai dengan bakat dan
kesanggupannya.
7. Memahami dan mampu bertingkah laku yang dapat dipertanggungjawabkan sesuai dengan norma-
norma dan nilai-nilai yang berlaku.
8. Memperoleh informasi tentang pernikahan dan mempersiapkan diri untuk berkeluarga.
9. Mendapatkan penilaian bahwa dirinya mampu bersikap tepat sesuai dengan pandangan ilmiah.
Mengingat tugas-tugas perkembangan tersebut sangat kompleks dan relatif berat bagi remaja, maka
untuk dapat melaksanakan tugas-tugas tersebut dengan baik, remaja masih sangat membutuhkan
bimbingan dan pengarahan supaya dapat mengambil langkah yang tepat sesuai dengan kondisinya. Di
samping tugas-tugas perkembangan, remaja masih mempunyai kebutuhan-kebutuhan yang tentu saja
menuntut pemenuhan secepatnya sesuai darah mudanya yang bergejolak. Kebutuhan-kebutuhan tersebut,
menurut Edward, sebagaimana dikutip Hafsah,19 adalah meliputi: (1) kebutuhan untuk mencapai sesuatu,
(2) kebutuhan akan rasa superior, ingin menonjol, ingin terkenal, (3) kebutuhan untuk mendapatkan
penghargaan, (4) kebutuhan akan keteraturan, (5) kebutuhan akan adanya kebebasan untuk menentukan
sikap sesuai dengan kehendaknya, (6) kebutuhan untuk menciptakan hubungan persahabatan, (7) adanya
keinginan ikut berempati, (8) kebutuhan mencari bantuan dan simpati, (9) keinginan menguasai tetapi
tidak ingin dikuasai, (10) menganggap diri sendiri rendah, (11) adanya kesediaan untuk membantu orang
lain, (12) kebutuhan adanya variasi dalam kehidupan, (13) adanya keuletan dalam melaksanakan tugas, (14)
kebutuhan untuk betgaul dengan lawan jenis, dan (15) adanya sikap suka mengkritik orang lain.
Intensitas kebutuhan-kebutuhan di atas tidak semua sama antara individu yang satu dengan yang
lain, karena kondisi pribadi yang berbeda, situasi lingkungan yang berlainan, dan ada individu yang ingin
segera kebutuhannya terpenuhi, namun kenyataannya banyak yang tidak terpenuhi. Dari uraian ini
nampak bahwa tugas perkembangan dan kebutuhan merupakan sesuatu yang muncul pada periode
tertentu dalam rentang kehidupan remaja. Apabila tugas dan kebutuhan dapat terpenuhi, maka membawa
kebahagiaan dan kesuksesan dalam menuntaskan tugas-tugas perkembangan berikutnya. Sebaliknya
apabila gagal, maka akan menyebabkan ketidakbahagiaan pada remaja yang bersangkutan, menimbulkan
penolakan masyarakat, dan kesulitan-kesulitan dalam menuntaskan tugas-tugas perkembangan peridode-
periode berikutnya.

18Gunarsa, S.D., dan Gunarsa, Y.S.,Psikologi Praktis: Anak, Remaja dan Keluarga, hlm.39.
19
Siti Hafsah Budi Argiati, . Perilaku Agresif Ditinjau dari Persepsi Pola Asuh Authoritarian, Asertivitas dan Tahap
Perkembangan Remaja Pada Anak Binaan Lembaga Pemasyarakata Anak Kutoarjo, Jawa Tengah, Tesis, hlm. 75-76.

APLIKASIA: Jurnal Aplikasi Ilmu-ilmu Agama, Vol. 17, No. 1, 2017 31

Khamim Zarkasih Putro

DAFTAR PUSTAKA

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Tengah, Tesis, tidak diterbitkan, Yogyakarta: Sekolah Pascasarjana UGM, 2008
Djiwandono, Sri Esti Wuryani, Psikologi Pendidikan, Edisi Revisi, Jakarta: Grasindo, 2008
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Hurlock. E.B., Psikologi Perkembangan Suatu Pendekatan Sepanjang Rentang Kehidupan, Jakarta:
Erlangga, 1993
Jahja, Yudrik, Psikologi Perkembangan, Jakarta: Kencana, 2011
Jatmika, Sidik, Genk Remaja, Anak Haram Sejarah ataukah Korban Globalisasi?, Yogyakarta: Kanisius,
2010
Jatmika, Sidik, Urip Ming Mampir Ngguyu, Telaah Sosiologis Folklor Jogja, Yogyakarta: Kanisius, 2009
Mappiare, A., Psikologi Remaja, Surabaya: Usaha Nasional, 2000
Monks, F.J. dan AMP Roney, Psikologi Perkembangan: Pengantar dalam Berbagai Bagian, Yogyakarta:
Gadjah Mada University Press, 2006
Putro, Khamim Zarkasih, Orangtua Sahabat Anak dan Remaja, Yogyakarta: Cerdas Pustaka, 2005
Santrock, Adolescence, Jakarta: Erlangga, 2003
____, Perkembangan Anak Edisi Kesebelas, Jilid 2, Jakarta: Penerbit Erlangga, 2007
Sarwono, Sarlito Wirawan, Psikologi Remaja, Jakarta: PT Rajawali Press, 2006
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Wirawan, S. Psikologi Remaja, Jakarta: Raja Grafindo Persada, 2002

32 APLIKASIA: Jurnal Aplikasi Ilmu-ilmu Agama, Vol. 17, No. 1, 2017

 PENGARUH INTERVENSI PENDIDIKAN KESEHATAN JIWA REMAJA
TERHADAP KEMAMPUAN MANAJEMEN STRES
(The Influence Of Adolescent Mental Health Education Towards Stress Management
Ability)
Hanik Endang Nihayati*, Lady Claudinie*, Candra Panji A.*, EstyYunitasari*, Ah.
Yusuf*, RizkiFitriyasari*

*Fakultas Keperawatan Universitas Airlangga

Kampus C Jalan Mulyorejo Surabaya, Telp. 031 5913754
Email: azzam_psik@yahoo.com

ABSTRAC

Introduction: Mental health education is a process of change in a person with the aim of
achieved mental healthy degree. Mental health education is one of the factors that affect
the ability of adolescent stress management and necessary in administered treatment for
adolescent to adapted with their stress and capable to managed them. The purpose of this
study is to identify the influence of mental health education of adolescent towards stress
management ability in Puskesmas Pacarkeling Surabaya. Methods: This study used pra
experimental pre and post test design by using total sampling purposive sampling that
obtained 20 respondent. Data was collected by stress management ability include
cognitive and affective responses questionnaire. Results: Data were analysed by
Wilcoxon Signed Rank Tests. Wilcoxon Tests results showed p = 0.000 (p≤0.05), means
that health mental adolescent affect the increased cognitive and affective responses in
stress management ability. Discussion: It can be concluded that mental health education
applied as early as possible will affect stress management ability of adolescent in reduced
stress and developed positive attitude.
Keyword: mental health education, adolescent, stress management ability.

PENDAHULUAN
Perubahan biologis, psikologis, kehidupan remaja jika mereka tidak
maupun sosial terjadi pada masa remaja mampu mengatasi stres tersebut(Stuart,
(Kusumawati, 2010). Remaja 2013). Stres yang ditimbulkan dapat
dihadapkan dengan berbagai perubahan berupa penyimpangan tingkah laku
yang sedang terjadi dalam dirinya emosional seperti: agresif, rasa takut
maupun target perkembangan yang yang berlebihan, sikap apatis, dan
harus dicapai sesuai dengan usianya tingkah laku menyakiti diri.Salah satu
(Stuart, 2013). Remaja juga berhadapan cara untuk menurunkan stres adalah
dengan berbagai tantangan yang pemberian intervensi pendidikan
berkaitan dengan pubertas, perubahan kesehatan jiwa sehingga remaja akan
peran sosial, dan lingkungan dalam memiliki pengetahuan dan kemampuan
usaha untuk mencapai untuk memanajemen stres.
kemandirian(Stuart, 2013). Tantangan
ini tentunya berpotensi untuk Jumlah remaja di dunia sekitar 1,2
menimbulkan masalah perilaku dan milyar atau 18% dari jumlah penduduk
memicu timbulnya stres dalam dunia (WHO, 2014). Jumlah kelompok

user | [SCHOOL] Prosiding Konferensi Nasional (Konas) XIV Ikatan Perawat Kesehatan Jiwa (IPKJI), Banjarmasin, 28 – 30 September 2017
 usia 10-19 tahun di Indonesia menurut untuk memanajemen stres yang
Sensus Penduduk 2010 sebanyak 43,5 dihadapi.
juta atau sekitar 18% dari jumlah
penduduk Indonesia. Data yang Stres barunyatadirasakanapabila
diperoleh dari Puskesmas Pacarkeling, keseimbangandiri mulai terganggu.
Kecamatan Tambaksari, Kota Surabaya, Artinya, stres terjadi saat persepsi
Jawa Timur, jumlah remaja yang berada tekanandaristresormelebihidaya tahan
di wilayah kerja Puskesmas Pacarkeling untukmenghadapi tekanan tersebut.
pada tahun 2016 sebanyak 6.850 orang. Reaksi terhadap stres bervariasi pada
setiap individu dariwaktu
Pada remaja sering terjadi masalah kewaktukarena pengaruh variabel
mental emosional (Dhamayanti, 2011). kondisi individu, karakteristik
Masalah mental emosional dapat timbul kepribadian, sosial-kognitif, hubungan
jika terdapat sesuatu yang menghambat dengan lingkungan sosial, dan strategi
seseorang dalam proses penyesuaian diri koping. Hal ini menyebabkan penilaian
dengan lingkungan dan pengalaman- terhadap stresor juga berbeda-beda
pengalamannya (Dhamayanti, 2011). pada setiap individu. Penilaian terhadap
Gambaran masalah mental emosional stresor meliputi penentuan arti dan
seperti gejala depresi, kecemasan, pemahaman terhadap pengaruh situasi
perilaku menarik diri, kesedihan, yang penuh dengan stres bagi individu.
perasaan bersalah, ketakutan dan Pendidikan kesehatan perlu diberikan
kekhawatiran berlebih sehingga pada individu untuk menilai serta
menghambat kesuksesan akademik dan membuat keputusan berdasarkan
hubungan dengan teman sebaya, pengetahuan dalam rangka memelihara
temperamen sulit, ketidakmampuan dan meningkatkan derajat kesehatan.
memecahkan masalah, gangguan Pendidikan kesehatan jiwa remaja
perhatian, hiperaktivitas, perilaku diberikan sebagai intervensi untuk
bertentangan (tidak suka ditegur/diberi mengidentifikasi masalah gangguan
masukan positif, tidak mau ikut aturan) emosional, penyebab stres, dan
dan perilaku agresif. Permasalahan yang manajemen stres pada remaja. Menurut
terjadi pada remaja juga berbeda. Teori Taksonomi Bloom, sasaran
Remaja awal usia 12 – 16 tahun atautujuanpendidikandiklasifikasikan
dikatakan sebagai periode yang paling menjaditigadomain, yaitu kognitif,
penuh stres dibandingkan dengan masa afektif, dan psikomotor (Winkel, 1987).
remaja pertengahan dan akhir (Krenke, Setiap ranah tersebut dibagi
2009). Walaupun demikian, dilaporkan kembalikedalam pembagian yanglebih
pada penelitian lain bahwa tingkat stres rinci berdasarkan hierarkinya.
yang relatif tinggi akan terus dialami Kemampuan individu remaja
pada masa remaja sampai usia 16 tahun, dapat ditingkatkan melalui pendidikan
setelah melewati usia 16 tahun, stres kesehatan jiwa remaja khususnya
mulai berkurang sedikit demi sedikit (Li, manajemen stres. Pendidikan kesehatan
2006). Keberadaan masalah-masalah adalah kegiatan untuk memberikan
pada usia muda diperkirakan akan pengetahuan, sikap dan praktek
meningkatkan stres pada usia masyarakat dalam memelihara dan
pertengahan. Oleh karena itu sangat meningkatkan kesehatan jiwa mereka
penting untuk dilakukan intervensi sendiri (Notoatmodjo, 2012).Pendidikan
pendidikan kesehatan jiwa remaja kesehatan jiwa adalah upaya untuk
sehingga remaja memiliki kemampuan mempengaruhi atau mengajak orang lain
baik individu, kelompok, atau

user | [SCHOOL] Prosiding Konferensi Nasional (Konas) XIV Ikatan Perawat Kesehatan Jiwa (IPKJI), Banjarmasin, 28 – 30 September 2017
 masyarakat agar melaksanakan perilaku (2009) sebanyak 20 orang. Populasi
sehat jiwa. Manajemen stres merupakan terjangkau yang bisa dijangkau peneliti
serangkaian strategi yang dapat dibatasi oleh waktu tahun 2017 dan
membantu seseorang untuk tempat sebanyak 20 orang. Populasi
memodifikasi berbagai perilaku yang terjangkau sudah sesuai dengan kriteria
beresiko terhadap kesehatan sehingga remaja awal usia 12-15 tahun, remaja
dapat memperbaiki kualitas hidup. pertengahan usia 16-18 tahun, dan
Manejemn stres dapat memperbaiki remaja akhir usia 19-21 tahun. Besar
kualitas hidup dan meningkatkan sampel dalam penelitian ini sebanyak 20
kesehatan, koping yang efektif, karena remaja yang diperoleh dengan teknik
itu mengurangi konsekuensi- total sampling. Variabel independen
konsekuensi yang tidak sehat dari distres pada penelitian ini adalah pendidikan
(Edelman & Mandle, 2010). Pendidikan kesehatan jiwa remaja dan variabel
kesehatan jiwa akan berpengaruh pada dependen pada penelitian ini adalah
manajemen stres pada remaja. Hal ini kemampuan manajemen stres pada
menjadikan kesehatan jiwa sebagai suatu remaja. Instrumen dari penelitian ini
yang bernilai serta mengajarkan remaja adalah kuesioner kognitif untuk
berperilaku sehat jiwa untuk beradaptasi mengukur kemampuan kognitif dan
terhadap stres. Tidak adanya pendidikan kuesioner afektif untuk mengukur
kesehatan jiwa menimbulkanmanajemen kemampuan afektif pada remaja dalam
stres yang kurang sehingga timbul memanajemen stres.
mekanisme koping maladaptif.
Analisis data yang digunakan
BAHAN DAN METODE dalam penelitian ini adalah uji Wilcoxon
Signed Rank Testuntuk mengetahui
Jenis penelitian yang digunakan komparatif dua sampel berkolerasi pada
adalah pra-eksperimental, dengan data berbentuk ordinal di masing-masing
rancangan One Group pre-post test variabel dependen. Interpretasi hasil uji
design. Populasi target dalam penelitian Wilcoxon Signed Rank Test adalah
ini adalah remaja yang berada di wilayah hipotesis (Ho) ditolak jika nilai
kerja Puskesmas Pacarkeling Surabaya. signifikansi≤ 0.05, sehingga dinyatakan
Populasi keseluruhan remaja di ada pengaruh yang signifikan antar dua
Posyandu Remaja Puskesmas variabel. Jika nilai signifikansi >0.05
Pacarkeling Surabaya sebanyak 30 maka tidak terdapat pengaruh signifikan
orang. Populasi target berdasarkan antar dua variable.
karakteristik remaja menurut Wiguna

HASIL PENELITIAN

Hasil penelitian ini meliputi karakteristik jenis kelamin, usia, pendidikan, dan
menganalisis pengaruh antar variabel.

Pada Tabel 1 menunjukkan bahwa sebagian besar remaja berjenis kelamin

perempuan yaitu 70% (14 orang). Usia responden sebagian besar berada pada rentang
usia 16-18 tahun yaitu 60% (12 orang). Pendidikan responden sebagian besar adalahSMP
yaitu 45% (9 orang).

Tabel 1. Distribusi frekuensi remaja berdasarkan jenis kelamin, usia, dan

pendidikan di Posyandu Remaja Puskesmas Pacarkeling Surabaya.

user | [SCHOOL] Prosiding Konferensi Nasional (Konas) XIV Ikatan Perawat Kesehatan Jiwa (IPKJI), Banjarmasin, 28 – 30 September 2017
 Responden
Data Demografi Kategori
Frekuensi (F) Persentase (%)
Laki-laki 6 30%
Jenis Kelamin
Perempuan 14 70%
Total 20 100%
12-15 8 40%
Usia 16-18 11 55%
19-21 1 5%
Total 20 100%
SMP 9 45%
SMA/ SMK 7 35%
Pendidikan
Perguruan Tinggi 2 10%
Bekerja 2 10%
Total 20 100%

Tabel 2 Distribusi nilai kemampuan manajemen stres dalam aspek kognitif pada
remaja di Posyandu Remaja Puskesmas Pacarkeling Surabaya sebelum dan setelah diberi
intervensi
Sebelum Sesudah
Kategori
F (%) F (%)
Kemampuan Kurang 3 15,0 0 0
Manajemen Cukup 12 60,0 3 15,0
Stres dalam
Aspek Baik 5 25,0 17 85,0
Kognitif
∑ 20 100,0 20 100,0
Wilcoxon Signed Rank Tests Nilai p = 0,000
Negative Ranks 0
Positive Ranks 20
Ties 0

Tabel 2 menunjukkan bahwa sebagian besar remaja sebelum diberikan intervensi

pendidikan kesehatan jiwa remaja berada pada kategori kognitif cukup (60% atau
sebanyak 12 orang). Sebanyak 25% (5 responden) berada pada kategori baik dan sebesar
15% (3 responden) masih memiliki pengetahuan yang kurang tentang manajemen stres.
Setelah diberikan intervensi pendidikan kesehatan jiwa remaja, didapatkan 85% (17
responden) berada pada kategori kognitif baik dan sebesar 15% (3 responden) berada
pada kategori cukup.
Hasil uji menggunakan Uji Wilcoxon yaitu p = 0,000 < 0,05 hal ini menunjukkan
bahwa intervensi pendidikan kesehatan jiwa remaja yang diberikan berpengaruh secara
bermakna terhadap kemampuan manajemen stres dalam aspek kognitif pada remaja,
sehingga H1 diterima. Ada pengaruh intervensi pendidikan kesehatan jiwa remaja
terhadap kemampuan manajemen stres remaja dalam aspek afektif. Data menunjukkan
bahwa semua responden mengalami peningkatan kemampuan manajemen stres dalam
aspek kognitif setelah dilakukan pendidikan kesehatan jiwa remaja.

user | [SCHOOL] Prosiding Konferensi Nasional (Konas) XIV Ikatan Perawat Kesehatan Jiwa (IPKJI), Banjarmasin, 28 – 30 September 2017
 Tabel 3 Distribusi kemampuan manajemen stres dalam aspek afektif pada remaja
di Posyandu Remaja Puskesmas Pacarkeling Surabaya sebelum dan setelah diberi
intervensi
Sebelum Sesudah
Kategori
F (%) F (%)
Kemampuan Negatif 8 40,0 3 15,0
Manajemen
Stres dalam
Positif 12 60,0 17 85,0
Aspek
Afektif
∑ 20 100,0 20 100,0
Wilcoxon Signed Rank Tests Nilai p = 0,000
Negative Ranks 1
Positive Ranks 18
Ties 1

Tabel 3 menunjukkan bahwa sebagian besar remaja sebelum diberikan intervensi

pendidikan kesehatan jiwa remaja berada pada kategori afektif positif (60% atau
sebanyak 12 orang) dan sebanyak 40% (8 responden) berada pada kategori afektif negatif.
Setelah diberikan intervensi pendidikan kesehatan jiwa remaja, didapatkan 85% (17
responden) berada pada kategori afektif positif dan sebesar 15% (3 responden) berada
pada kategori afektif negatif.
Hasil uji menggunakan Uji Wilcoxon yaitu p = 0,000 < 0,05 hal ini menunjukkan
bahwa intervensi pendidikan kesehatan jiwa remaja yang diberikan berpengaruh secara
bermakna terhadap kemampuan manajemen stres dalam aspek afektif pada remaja,
sehingga H1 diterima. Ada pengaruh intervensi pendidikan kesehatan jiwa remaja
terhadap kemampuan manajemen stres remaja dalam aspek afektif. Data menunjukkan
bahwa 18 responden mengalami peningkatan kemampuan manajemen stres dalam aspek
afektif setelah dilakukan pendidikan kesehatan jiwa remaja, 1 responden mengalami
penurunan kemampuan manajemen stres, dan 1 orang tidak mengalami peningkatan
maupun penurunan kemampuan manajemen stres dalam aspek afektif.

Manajemen stres merupakan Data khusus pada tabel 5.2

serangkaian strategi yang dapat menunjukkan bahwa sebelum diberikan
membantu seseorang untuk pendidikan kesehatan jiwa remaja,
memodifikasi berbagai perilaku yang sebagian besar remaja masih memiliki
beresiko terhadap kesehatan sehingga kemampuan manajemen stres dalam
dapat memperbaiki kualitas hidup. aspek kognitif yang cukup. Aspek
Intervensi pendidikan kesehatan jiwa kognitif yang cukup menggambarkan
diberikan dengan tujuan untuk remaja sudah memiliki pengetahuan atau
memberikan pendidikan sehat jiwa bagi pengalaman tentang manajemen stres
remaja sehingga remaja memiliki pada remaja.
kemampuan manajemen stres yang Menurut teori sosial kognitif
positif. Pendidikan kesehatan jiwa Bandura (1986) dalam Notoadmodjo
bertujuan untuk menerapkan proses (2012), perilaku merupakan hasil
belajar bagi remaja pada aspek kognitif interaksi antara proses kognitif dan
dan afektif dalam manajemen stres. kejadian di lingkungan. Proses belajar

user | [SCHOOL] Prosiding Konferensi Nasional (Konas) XIV Ikatan Perawat Kesehatan Jiwa (IPKJI), Banjarmasin, 28 – 30 September 2017
 merupakan proses yang tidak langsung dengan remaja. Informasi yang diberikan
atau melalui observasi. Pengetahuan oleh peneliti dapat menjadi pengalaman
remaja yang cukup tentang manajemen remaja tentang pendidikan kesehatan
stres merupakan hasil interaksi remaja jiwa remaja. Pengalaman yang
terhadap lingkungan sekitar sehingga didapatkan kemudian mengedukasi
mendapatkan informasi dan remaja sehingga kemampuan
pengalaman. Informasi tantang manajemen stres remaja dalam aspek
manajemen stres yang diterima remaja kognitif mengalami peningkatan.
dapat berasal dari media cetak yang Tahap perkembangan remaja
berupa majalah, koran dan buku serta meliputi tumbuh kembang intelektual
berasal dari media elektronik seperti yang berkaitan dengan kemampuan
acara life style pada televisi, radio, dan berkomunikasi dan menangani berbagai
internet. Beberapa remaja mengatakan masalah abstrak dan simbolik, seperti
bahwa mengerti tentang definisi stres bicara, bermain, berhitung atau
dan penyebab timbulnya stres tanpa membaca. Sedangkan tumbuh kembang
memahami tentang masalah mental emosional berkaitan dengan kemampuan
emosional pada remaja. membentuk ikatan batin, berkasih
Tabel 5.2 menunjukkan bahwa sayang, mengelola rangsang dari luar
kemampuan manajemen stres dalam serta kemampuan menangani
aspek kognitif pada remaja setelah diberi kegelisahan akibat suatu kegagalan
intervensi meningkat. Menurut Skinner (Sudoyo, 2006). Remaja berusaha untuk
yang dikutip oleh Notoatmodjo (2012), belajar dengan mendapatkan pendidikan
perilaku merupakan respon atau reaksi yang telah diberikan. Sebagian besar
seseorang terhadap stimulus atau remaja dengan usia 16 - 21 tahun
rangsangan dari luar. Peneliti memiliki aspek kognitif yang baik dalam
menerapkan teori tersebut untuk manajemen stres. Peningkatan yang
merubah perilaku subjek menjadi yang dialami remaja dari kategori cukup
diharapkan. Peneliti memberikan menuju baik terdiri dari usia yang
stimulus berupa intervensi pendidikan bervariasi. Remaja berpikir dengan cara
kesehatan jiwa remaja yang dikemas yang berbeda di berbagai usia. Konflik
melalui paparan informasi tentang stres yang sering dihadapi oleh remaja
pada remaja dan manajemen stres. semakin kompleks seiring dengan
Informasi yang diberikan kepada subjek bertambahnya usia dan perubahan yang
disajikan berupa booklet yang menarik. mereka alami pada berbagai dimensi
Stimulus yang diberikan kemudian kehidupan dalam diri mereka. Hal ini
ditangkap oleh remaja dan memberikan menyebabkan hasil yang didapatkan dari
respon. Respon yang diberikan oleh responden bervariasi.
subjek dibuktikan dengan adanya Tabel 3 menunjukkan data khusus
pengaruh pendidikan kesehatan jiwa remaja tentang kemampuan manajemen
remaja terhadap kemampuan manajemen stres dalam aspek afektif sebelum dan
stres pada remaja. Sejalan dengan Teori sesudah diberi intervensi pendidikan
Skinner yaitu stimulus – organisme – kesehatan jiwa remaja. Menurut Teori
respon. Bloom dalam Damyati (2009),
Asumsi dasar Piaget dalam Ormord kemampuan manajemen stres dalam
(2008), remaja mengonstruksi asfek afektif terdiri dari lima ranah yang
pengetahuan berdasarkan pengalaman. berhubungan dengan respons emosional
Peneliti memberikan intervensi berupa terhadap tugas yaitu penerimaan,
penyampaian informasi dan diskusi partisipasi, penilaian atau penentuan

user | [SCHOOL] Prosiding Konferensi Nasional (Konas) XIV Ikatan Perawat Kesehatan Jiwa (IPKJI), Banjarmasin, 28 – 30 September 2017
 sikap, organisasi dan pembentukan pola
hidup. Afektif negatif terjadi apabila
kelima ranah tersebut tidak dilalui
dengan baik (Damyati, 2009). Salah satu
faktor yang mempengaruhi aspek afektif
yaitu usia (Krenke, 2009). Remaja awal
usia 12 – 16 tahun merupakan periode
yang paling penuh stres dibandingkan
dengan masa remaja pertengahan dan
akhir (Krenke, 2009). Tingkat stres yang
relatif tinggi akan terus dialami pada
masa remaja sampai usia 16 tahun,
setelah melewati usia 16 tahun, stres
mulai berkurang sedikit demi sedikit (Li,
2006).
Afektif negatif remaja dapat
disebabkan oleh usia remaja dan
lingkungan sekitar yang kurang
menanamkan keyakinan tertentu dalam
manajemen stres. Pada usia 12-16 tahun,
remaja belum mampu beradaptasi
terhadap stresor yang dialami.
Pendidikan kesehatan jiwa juga kurang
disosialisasikan kepada remaja, orang
tua maupun guru di sekolah. Kategori
negatif yang dimiliki remaja tersebut
menunjukkan bahwa siswa memerlukan
arahan agar aspek afektif remaja menjadi
positif. Sikap negatif tersebut
berkecenderungan menjadi suatu
perilaku tidak sehat.
Tabel 3 menunjukkan bahwa aspek
afektif remaja dalam menghadapi stres
setelah diberikan intervensi pendidikan
kesehatan jiwa remaja mengalami
perubahan positif yang signifikan namun
beberapa remaja masih berada dalam
kategori afektif negatif. Alport (1954)
dalam Notoatmodjo (2012),
mengungkapkan bahwa sikap atau
respon afektif ialah respon tertutup
seseorang terhadap suatu objek atau
stimulus tertentu, yang disertai dengan
faktor pendapat dan emosi yang
bersangkutan. Respon tertutup dari siswa
tidak mudah digali oleh peneliti. Peneliti
seharusnya dapat menggali lebih lagi
pada faktor emosi remaja melalui
user | [SCHOOL] Prosiding Konferensi Nasional (Konas) XIV Ikatan Perawat Kesehatan Jiwa (IPKJI), Banjarmasin, 28 – 30 September 2017
observasi kegiatan remaja sehari-hari
dan wawancara terhadap remaja.
Respon afektif dapat bersifat
positif dan dapat pula bersifat negatif,
afektif positif memiliki kecenderungan
tindakan mendekati, menyenangi,
mengharapkan obyek tertentu,
sedangkan afektif negatif terdapat
kecenderungan untuk menjauhi,
menghindari, membenci, tidak menyukai
obyek tertentu (Purwanto, 2010).
Peningkatan afektif remaja sebelum dan
sesudah diberikan intervensi
menunjukkan hasil yang signifikan
namun masih ada remaja yang berada
pada kategori afektif negatif. Afektif
remaja dalam manajemen stres lebih
dipengaruhi oleh lingkungan sekitar
seperti lingkungan keluarga, orang tua,
teman sebaya. Kebiasaan menunda
menyelesaikan masalah sulit dirubah
jika hanya dengan pemberian intervensi
pendidikan kesehatan jiwa yang tidak
berkelanjutan.
Hasil analisa didapatkan bahwa sebagian
siswa tidak mengalami penurunan atau
peningkatan kategori afektif dalam
manajemen stres. Hal tersebut dapat
dipengaruhi oleh pemberian informasi
dan pendidikan kesehatan jiwa remaja
yang diterima oleh remaja kurang
optimal. Setiap remaja tumbuh dengan
keunikan sendiri dan laju pertumbuhan
yang bervariasi disebabkan faktor luar
berupa informasi yang remaja terima dan
konstruksikan sendiri (Santrock, 2007).
Afektif remaja apabila ditinjau dari
usia, terdapat beberapa yang tidak
mengalami
penurunan atau peningkatan kategori.
Remaja yang tidak mengalami kenaikan
atau penurunan kategori afektif sebagian
besar adalah remaja pertengahan yaitu
usia < 16 tahun. Stresor yang lebih besar
dihadapi pada remaja awal. Remaja awal
dihadapkan dengan berbagai stresor
seperti harus beradaptasi terhadap
pubertas seperti perubahan fisik, mental,
 dan emosional pada diri remaja serta Ethnic Minority Status, and Home
beradaptasi dengan tugas dan kewajiban and School Related Hassles. Child
di sekolah. Hal ini menyebabkan remaja and Adolescent Psychiatry and
tidak mudah untuk beradaptasi terhadap Mental Health.
stres dan menerapkan manajemen stres. Damayanti, Yulisya. 2013. Perbedaan
Simpulan Tingkat Stres Sebelum dan Setelah
Pelatihan Manajemen Stres pada
Intervensi pendidikan kesehatan Mahasiswa Tingkat Akhir di
jiwa remaja dapat meningkatkan Asrama Aceh. Jurnal Fakultas
kemampuan manajemen stres pada Psikologi (Juli). Vol. 2 No. 1, Hal.
remaja di Posyandu Remaja Puskesmas 1-16.
Pacarkeling surabaya. Namun dalam
Martono, L. H. & Joewana, S. 2008.
pelaksanaanya, keberhasilan remaja
Belajar Hidup Bertanggung
dalam manajemen stres pada aspek
Jawab, Menangkal Narkoba dan
afektif tidak semua mengalami
Kekerasan. Jakarta: Balai Pustaka.
peningkatan. Hal ini dapat terjadi karena
pada aspek afektif, individu melewati National Academies Press. 2009.
fase penerimaan, partisipasi, penilaian, Preventing mental, emotional, and
penentuan sikap, organisasi, dan behavioral disorders among young
pembentukan pola hidup yang berbeda. people: progress and possibilities.
Committee on the Prevention of
Saran Mental Disorders and Substance
Hasil penelitian ini diharapkan AbuseAmong Children, Youth, and
bisa memberikan informasi tambahan Young Adults. Washington, D.C.
dalam memberikan pendidikan Stuart, Gail W. 2013. Principles &
kesehatan jiwa remaja dalam Practice of Psychiatric Nursing 9th
memanajemen stres. Peneliti selanjutnya ed. Philadelphia: Elssevier Mosby
diharapkan dapat memilih metode
pendidikan kesehatan jiwa yang lain Tiffin A.P. Arnott B., Moore J.H.,
guna meningkatkan kemampuan Summerbell D.C. 2007. Modelling
manajemen stres pada remaja. the Relationship between Obesity
and Mental Helath in Children and
Adolescent:finding from Health
Survey for England. Child and
Adolescent Psychiatry and
DaftarPustaka MentalHealth.
Alves D, Roysamb E, Oppedal B, Yusuf, A., Fitryasari, R., & Nihayati, H.
Zachrisson H. 2011. Emotional E. 2015. Buku Ajar Keperawatan
Problems in Preadolescents in Kesehatan Jiwa. Jakarta: Salemba
Norway: The Role of Gender, Medika.

user | [SCHOOL] Prosiding Konferensi Nasional (Konas) XIV Ikatan Perawat Kesehatan Jiwa (IPKJI), Banjarmasin, 28 – 30 September 2017

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 KESEHATAN JIWA REMAJA

1)
Ririn Nasriati
1)
Program Studi DIII Keperawatan
Fakultas Ilmu Kesehatan Universitas Muhammadiyah Ponorogo

ABSTRAK
Remaja adalah individu yang unik dengan segala proses perkembangan yang harus dilaluinya
baik secara fisik maupun psikologis. Masa remaja merupakan masa transisi dan merupakan masa yang
sulit bagi remaja sehingga kemungkinan akan terjadi perubahan perilaku terkait dengan
perkembangan yang terjadi pada remaja tersebut.
Pada masa ini, remaja mempunyai tugas – tugas perkembangan yang dapat menjadi ancaman
bagi remaja dan juga sangat dipengaruhi oleh faktor – faktor lingkungan. Adanya hambatan dalam
tahap perkembangan dapat menimbulkan masalah kesehatan jiwa bila tidak terselesaikan dengan baik.
Masalah tersebut dapat berasal dari remaja sendiri, hubungan dengan orang tua atau akibat interaksi
sosial diluar lingkungan keluarga. Dampak selanjutnya adalah munculnya gangguan psikotik yang
bisa berlanjut sampai masa dewasa
Agar kesehatan jiwa remaja dapat tercapai maka deteksi dini dan intervensi dini perlu
dilakukan dengan melibatkan keluarga maupun remaja sendiri sehingga masalah – masalah kejiwaan
remaja dapat diatasi dengan baik.

Kata kunci : kesehatan jiwa, remaja

PENDAHULUAN diatasi dapat berlanjut sampai dewasa dan dapat

Masa remaja merupakan suatu fase
perkembangan antara masa kanak – kanak dan
masa dewasa, berlangsung antara usia 10 – 19
tahun. Masa remaja terdiri dari remaja awal ( 10
– 14 tahun ), masa remaja pertengahan ( 14- 17
tahun )dan masa remaja akhir (17 – 19 tahun).
Pada masa remaja terjadi banyak perubahan baik
biologis, psikologis maupun sosial (Kusumawati,
F, 2010).
Seorang remaja tidak lagi dapat disebut
sebagai anak kecil, tetapi belum juga dapat
dianggap sebagai orang dewasa. Disatu sisi ia
ingin bebas dan mandiri, lepas dari pengaruh
orang tua tetapi disisi lain pada dasarnya tetap
membutuhkan bantuan, dukngan dan
perlindungan orang tuanya. Orang tua sering
tidak mengetahui atau memahami perubahan
yang terjadi sehingga tidak menyadari bahwa
mereka telah tumbuh menjadi seorang remaja,
bukan lagi anak yang selalu dibantu.Orang tua
menjadi bingung menghadapi labilitas emosi dan
perilaku remaja sehingga akan terjadi konflik
diantara keduanya.
Konflik yang terjadi antara orang tua dan
remaja apabila tidak terselesaikan akan
berdampak negatif terhadap diri remaja sendiri
ataupun hubungan antara remaja dan orang
tuanya. Kondisi seperti ini bila ridak segera
berkembang kearah yang lebih negatif. Antara
lain dapat timbul masalah maupun gangguan
kejiwaan dari ringan sampai berat. Apabila pada
kenyataannya perhatian masyarakat lebih
terfokus pada upaya meningkatkan kesehatan
fisik semata dan kurang memperhatikan faktor
non fisik( intelektual, mental emosional dan
psikososial ) padahal faktor- faktor tersebut
merupakan penentudalam keberhasilan seorang
remaja dikemudian hari.
Faktor non fisik yang berpengaruh pada
remaja adalah lingkungan, yang meliputi
lingkungan keluarga, lingkungan sekolah, serta
lingkungan masyarakat sekitarnya. Oleh karena
itu orang tua atau orang yang berhubungan
dengan remaja perlu mengetahui ciri
perkembangan jiwa remaja , pengaruh
lingkungan terhadap perkembangan jiwa remaja
serta masalah maupun gangguan jiwa remaja.
Pengetahuan tersebut dapat membantu
mendeteksi secara dini bila terjadi perubahan
yang menjurus kepada hal negatif. Masalah
kesehatan jiwa terjadi pada 15 -22 % anak-anak
dan remaja, namun yang mendapatkan
pengobatan jumlahnya kurang dari 20 %.
Diagnosa gangguan jiwa pada anak- anak dan
remaja adalah perilaku yang tidak sesuai dengan
tingkat usianya, menyimpang bila dibandingkan
dengan norma budaya yang mengakibatkan
kurangnya atau terganggunya fungsi adaptasi
(Kusumawati, F, 2010).
Dasar memahami gangguan jiwa yang
terjadi pada remaja adalah dengan menggunakan
teori perkembangan. Penyimpangan dari norma
perkembangan merupakan tanda adanya suatu
masalah.
PERKEMBANGAN REMAJA
Perkembangan Fisik
Perubahan – perubahan fisik merupakan
gejala primer dalam pertumbuhan masa remaja
yang berdampak terhadap perubahan- perubahan
psikologis.8
Anak Perempuan
Perkembangan fisik anak perempuan
mulai berkembang pada usia 10,5 tahun dan
paling cepat pada usia 12 tahun.Perkembangan
fisik pada anak perempuan meliputi : 1)
pertumbuhan fisik yang pesat ( usia 10 – 11
tahun ); 2) pertumbuhan payudara ( 10 – 11
tahun ); 3) tumbuhnya rambut pubis (10 – 11
tahun ), dan rambut ketiak ( 12 – 13 tahun ); 4)
pengeluaran sekret vagina ( 10 – 13 tahun ); 5)
produksi kelenjar keringat ( 12-13 tahun); 6)
menstruasi ( 11 – 14 tahun ). Perkembangan fisik
pada anak perempuan nampaknya tidak sejalan
dengan pematangan psikologisnya. Payudara
yang tumbuh lebih dini seringkali menimbulkan
rasa malu karena sudah diperlakukan sebagai
orang dewasa padahal remaja ini belum siap
untuk menghadapinya.
Anak Laki – Laki
Perkembangan fisik pada anak laki- laki
2 tahun lebih lambat mulainya,namun akhirnya
anak laki- laki bertambah 12 – 15 cm dalam 1
tahun hingga pada usia 13 sampai menjelang 14
tahun. Perkembangan fisik pada anak laki-laki
meliputi: 1) pertumbuhan fisik yang pesat (12-13
tahun); 2) pertumbuhan testis dan skrotum (11-
12 tahun ); 3) perkembangan penis (12-13tahun);
4) terjadi ejakulasi (13-14 tahun); 5)
pertumbuhan rambut pubis (11-12tahun),rambut
ketiak dan badan (13-15tahun ), kumis,cambang,
jenggot ( 13-15 tahun); 6) perkembangan
kelenjar keringat ketiak (13 – 15 tahun ); 7) suara
pecah dan membesar (14-15 tahun ).
Perkembangan fisik pada anak
perempuan maupun laki-laki yang begitu cepat
dan drastis pada usia 11 samapai 16 tahun
membutuhkan waktu beberapa saat untuk dapat
beradaptasi dengan keadaan tersebut.
Perkembangan Psikososial
Perkembangan psikososial pada remaja
menurut Erikson adalah identitas dan
kebingungan peran yang terjadi pada usia 12-20
tahun. Pembentukan identitas selama masa
remaja merupakan tugas utama dalam
perkembangan kepribadian yang diharapkan
tercapai pada masa remaja akhir.Selama masa
remaja ini kesadaran akan identitas menjadi
lebih kuat karena itu ia berusaha mencari
identitas dan mendefinisikan kembali
“siapakah”ia saat ini dan akan menjadi
“siapakah” atau menjadi “apakah” ia dimasa
mendatang.Perkembangan identitas selama masa
remaja ini juga sangat penting karena ia
memberikan suatu landasan bagi perkembangan
psikososial dan relasi interpersonalpada masa
dewasa.
Tahap perkembangan identitas(Desmita,
2005) meliputi: 1) tahap diferensiasi (12-14
tahun ) karakteristik tahap ini adalah remaja
menyadari bahawa ia berbeda secara psikologis
dari orang tuanya.Kesadaran ini sering
membuatnya mempertanyakan dan menolak
nilai- nilai dan nasehat orang tuanya, sekalipun
nilai dan nasehat tersebut masuk akal; 2) tahap
praktis (14 – 15 tahun) arakteristik tahap ini
adalah remaja percaya bahwa ia mengetahui
segala-galanya dan dapat melakukan sesuatu
tanpa salah. Ia menyangkal kebutuhan akan
peringatan atau nasehat dan menantang
orangtuanya pada setiap kesempatan.
Komitmennya terhadap teman-teman juga
bertambah; 3) tahap penyesuaian (15-18 tahun).
Karakteristik tahap ini adalah karena kesedihan
dan kekhawatiran yang dialaminya mendorong
remaja untuk menerima kembali sebagian
otoritas orang tuanya tetapi dengan syarat.
Tingkah lakunya sering silih berganti antara
eksperimentasi dan penyesuaian, kadang mereka
menantang dan kadang berdamai dan
bekerjasama dengan orang tua mereka. Disatu
sisi ia menerima tanggung jawab di sekitar
rumah namun disisi lain ia akan mendongkol
ketika orang tuanya selalu mengontrol,
membatasi gerak gerik dan aktifitasnya diluar
rumah.; 4) tahap konsolidasi (18-21 tahun).
Karakteristik pada tahap ini adalah remaja
mengembangkan kesadaran akan identitas
personal yang menjadi dasar pemahaman dirinya
dan orang lainserta untuk mempertahankan
otonomi, independen dan invidualitas.
Selama masa ini remaja mulai memiliki
suatu perasaan tentang identitasnya sendiri, suatu
perasaan bahwa dia adalah manusia yang unik
dengan sifat-sifat yang melekat pada dirinya,
seperti kesukaan dan ketidaksukaan, tujuan yang
ingin dicapai pada masa mendatang, kekuatan
dan hasrat untuk mengontrol kehidupannya
sendiri.ini merupakan saat yang sulit bagi remaja
karena masa peralihan dari masa kanak-kanak ke
masa dewasa di satu pihak dan kepekaaan
terhadap perubahan sosiial dan historis dipihak
lain sehingga seorang remaja merasakan
penderitaan paling dalamdibandingkan dengan
masa-masa lain akibat kekacauan peranan atau
kekacauan identitas (identity confusion). Kondisi
ini menyebabkan remaja merasa terisolasi ,
hampa, cemas, dan bimbang.Remaja juga
menjadi mudah tersinggung dan merasa
malu.Selama masa ini tingkah laku remaja tidak
konsisten dan tidak dapat diprediksi kadang
tertutup terhadap siapapun karena takut ditolak
atau dikecewakan namun pada saat lain mungkin
ingin jadi pengikut atau pecinta dengan tidak
memperdulikan konsekwensi – konsekwensi dari
komitmennya (Davdson G C, 2006).
Remaja yang berhasil mencapai suatu
identitas diri yang stabil akan memperoleh suatu
pandangan yang jelas tentang dirinya, memahami
perbedaan dan persamaannya dengan orang lain,
menyadari kelebihan dan kekurangan dirinya,
penuh percaya diri, tanggap terhadap berbagai
situasi, mampu mengambil keputusan penting,
mampu mengantisipasi tantangan masa depan
serta mengenal perannya dimasyarakat (Desmita,
2005)
Perkembangan Psikososial Remaja Awal ( 10
– 14 Tahun )
Perkembangan psikososial remaja awal
diantaranya: 1) cemas terhadap penampilan
badan / fisik; 2) perubahan hormonal; 3)
menyatakan kebebasan dan merasa sebagai
seorang individu, tidak hanya sebagai anggota
keluarga; 4) perilaku memberontak dan
melawan; 5) kawan menjadi lebih penting; 6)
perasaan memiliki terhadap teman sebaya, anak
laki-laki membentuk gang, kelompok, anak
perempuan mempunyai sahabat; 7) sangat
menuntut keadilan tapi cenderung melihat
sesuatu sebagai hitam putih serta dari sisi
pandang mereka sendiri.
Dampak terhadap anak diantaranya: 1) kesadaran
diri meningkat (self consciousness ); 2) menjadi
pemarah, anak laki-laki yang tadinya baik dapat
menjadi agresif; 3) bereksperimen dengan cara
berpakaian, berbicara dan cara penampilan diri
sebagai suatu usaha untuk mendapatkan
identitas baru; 4) kasar dan menuntut
memperoleh kebebasan; 5) ingin tampak sama
dengan teman dalam cara berpakaian, gaya
rambut, mendengarkan musik; 6) pengaruh
teman menjadi sangat besar, remaja tidak mau
berbeda dengan dari teman sebaya; 7) tampak
tidak toleransi dan sulit berkompromi, timbul iri
hati dengan saudara kandung.
Perkembangan Psikososial Remaja
Pertengahan (15-16 Tahun )
Perkembangan psikososial remaja awal
diantaranya: 1) lebih mampu berkompromi; 2)
belajar berfikir secara independen dan membuat
keputusan sendiri; 3) terus menerus
bereksperimen untuk mendapatkan citra diri yang
dirasakan nyaman bagi mereka; 4) merasa perlu
mengumpulkan pengalaman baru, mengujinya
walaupun beresiko; 5) tidak lagi terfokus pada
diri sendiri; 6) membangun norma/nilai dan
mengembangkan realitas; 7) membutuhkan lebih
banyak teman dan rasa setia kawan; 8) mulai
membina hubungan lawan jenis; 9) intelektual
lebih berkembang dan ingin tahu banyak
hal,berfikir abstrak; 10) berkembangnya
ketrampilan intelektual khusus; 11)
mengembangkan minat yang besar terhadap
bidang seni dan olah raga; 12) senang
berpetualang,ingin bepergian sendiri.
Dampak terhadap anak diantaranya: 1) lebih
tenang, sabar dan lebih toleransi. dapat menerima
pendapat orang lain meskipun berbeda dengan
pendapatnya sendiri; 2) menolak campur tangan
orang tua; 3) baju, gaya rambut , sikap dan
pendapat mereka sering berubah-ubah; 4) mulai
bereksperiman dengan rokok , alkohol dan
napza; 5) lebih bersosialisasi dan tidak lagi
pemalu; 6) mempertanyakan nilai , norma yang
diterima dari keluarga; 7) menghabiskan waktu
lebih banyak dengan teman, mulai pacaran; 8)
mulai mempertanyakan sesuatu yang sebelumnya
tidak berkesan. ingin mengikuti debat dan
diskusi; 9) mungkin mengabaikan pelajaran
sekolah karena adanya minat yang baru.
perkembangan psikososial remaja akhir ( 17-19
tahun ) diantaranya: 1) ideal; 2) terlibat dalam
kehidupan, pekerjaan dan hubungan diluar
keluarga; 3) harus belajar untuk
mencapaikemandirian baik dalam bidang
finansial maupun emosional; 4) lebih mampu
membuat hubungan yang stabil dengan lawan
jenis; 5) merasa sebagai orang dewasa yang
setara dengan anggota keluarga lainnya; 6)
hampir siap untuk menjadi arang dewasa yang
mandiri.
Dampak terhadap anak diantaranya: 1)
cenderung menggeluti masalah sosial politik,nilai
– nilai agama; 2) mulai belajar mengatasi stress
yang dihadapinya; 3) kecemasan dan
ketidakpastian masa depan dapat merusak harga
diri remaja; 4) mempunyai pasangan yang lebih
serius; 5) cenderung merasa pengalamannya
berbeda dengan orang tua
PENGARUH LINGKUNGAN TERHADAP
PERKEMBANGAN JIWA REMAJA
Lingkungan Keluarga
Pola Asuh Keluarga
Proses sosialisasi sangat dipengaruhi oleh pola
asuh dalam keluarga (1) pola asuh yang otoriter
akan menyebabkan remaja berkembang menjadi
penakut, tidak memiliki rasa percaya diri, merasa
tidak berharga, sehingga proses sosialisasi
terganggu (2) Pola asuh permisif akan
menumbuhkan sikap ketergantungan dan sulit
menyesuaikan diri (3 ) pola asuh demokratis
akan menimbulkan kesimbangan antara
perkembangan individu dan sosial sehingga anak
akan memperoleh suatu kondisi mental yang
sehat.
Kondisi Keluarga
Hubungan orang tua yang harmonis akan
menumbuhkan kehidupan emosional yang
optimal terhadap perkembangan kepribadian
anak.
Pendidikan moral dalam keluarga
Pendidikan moral dalam kelurga adalah upaya
menanamkan nilai-nilai akhlak atau budi pekerti
kepada anak dirumah. Budi pekerti mengandung
nilai-nilai keagamaan, kesusilaan dan
kepribadian. Apabila keluarga tidak perduli
terhadap pendidikan moral dalam keluarga akan
berakibat buruk terhadap perkembangan jiwa
remaja.
Lingkungan sekolah
Lingkungan sekolah mempunyai pengaruh yang
kuat terhadap perkembangan remaja. Suasana
sekolah sangat berpengaruh terhadap
perkembangan jiwa remaja yaitu dalam hal
kedisiplinan, kebiasaan sekolah, pengendalian
diri dan bimbingan guru.
Lingkungan teman sebaya
Remaja lebih banyak berada diluar rumahdengan
teman sebaya. Jadi dapat dimengerti bahwa
sikap, pembicaraan, minat, penampilan dan
perilaku teman sebaya lebih besar pengaruhnya
daripada keluarga. Kelompok sebaya
memberikan lingkungan yaitu dunia tempat
remaja dapat melakukan sosialisasi dimana nilai
yang berlaku bukanlah nilai yang ditetapkan oleh
orang dewasa melainkan oleh teman seusianya.
Disinilah letak bahayanya bagi perkembangan
jiwa remaja
Lingkungan masyarakat
Lingkungan masyarakat yang berpengaruh
terhadap perkembangan jiwa remaja adalah
sosial budaya dan media massa. Pergeseran
budaya lokal dan budaya nasional akan
tertembus oleh budaya universal sehingga terjadi
pergeseran nilai kehidupan. Pergeseran nilai ini
akan menyebabkan konflik nilai yang dapat
berakibat terjadinya penyimpangan perilaku pada
remaja (Kusumawati, F, 2010).
MASALAH KESEHATAN JIWA REMAJA
Adanya hambatan dalam tahap
perkembangandapat menimbulkan masalah
kesehatan jiwa bila tidak terselesaikan dengan
baik. Masalah tersebut berasal dari diri remaja
sendiri, hubungan orang tua dan remaja atau
akibat interaksi sosial di luar lingkungan
keluarga. Sebagai akibatnya dapat terjadi
masalah kesehatan jiwa remaja
denganmanifestasi bermacam-macam antara lain
kesulitan belajar,kenakalan remaja dan masalah
perilaku seksual (Davdson G C, 2006).
Gangguan Jiwa Pada Remaja
Beberapa jenis gangguan jiwa yang banyak
terjadi pada remaja
Gangguan Cemas/ Ansietas
Cemas (ansietas)adalah perasaan gelisah
yang dihubungkan dengan antisipasi terhadap
bahaya. Gangguan cemas merupakan gangguan
yang banyak terjadi pada anak dan remaja.
Prevalensi gangguan cemas ini adalah 5 – 50 %.6
Fobia sosial ditemukan lebih banyak pada anak
laki-laki sedangkan fobia simpel, gangguan
menghindar lebih banyak pada anak perempuan.
Gangguan Mood
Depresi pada anak- anak dan remaja
berkisar antara 1 – 5 %. Seorang remaja
mempunyai kecenderungan untuk mengalami
depresi. Oleh karena itu sangat penting untuk
membedakan secara jelas dan hati – hati antara
depresi yang disebabkan oleh gejolak mood yang
normal pada remaja dengan depresi patologik.
Depresi pada remaja sering tidak terdiagnosis.
Adanya gangguan mood akan beresiko terjadinya
perilaku bunuh diri pada remaja. Bunuh diri
adalah penyebab kematian utama ketiga pada
individu berusia 15 – 24 tahun. Tanda – tanda
bahaya bunuh diri pada remaja meliputi menarik
diri secara tiba-tiba, berperilaku keras atau sangat
memberontak, menyalahgunakan obat atau
alkohol, secara tidak biasa mengabaikan
penampilan diri, kualitas tugas sekolah menurun,
membolos, keletihan berlebihan dan keluhan
somatik, respon yang buruk terhadap pujian,
ancaman bunuh diri terang-terangan secara
verbal dan membuang benda-benda yang didapat
sebagai hadiah .7
Gangguan Psikotik
Gangguan psikotik adalah suatu kondisi
terdapatnya gangguan yang berat dalam
kemampuan menilair realitas.5 Yang termasuk
gangguan psikotik adalah skizoprenia.
Skizoprenia pada remaja merupakan hal yang
umum dan insidennya selama remaja akhir
sangat tinggi. Gejala awalnya meliputi perubahan
ekstrem dalam perilaku sehari- hari, isolasi
sosial, sikap yang anah,penurunan nilai akademik
dan mengekspresikan peilaku yang tidak
disadarinya (Kusumawati, F, 2010).
Gangguan Penyalahgunaan Zat
Gangguan ini banyak terjadi
diperkirakan 32 % remaja menderita gangguan
penyalahgunaan zat (Kusumawati, F, 2010).
Angka penggunaan alkohol atau zat terlarang
lebih banyak pada anak laki-laki dibanding
perempuan. Resiko terbesar pada usia 15 – 24
tahun. Pada remaja perubahan penggunaan zat
menjadi ketergantungan zat terjadi lebih cepat
dalam kurun waktu 2 tahun. Identifikasi remaja
penyalahguna NAPZA terdapat pada konflik
keluarga yang berat, kesulitan akademik,
penyalahgunaan NAPZA oleh orang tua dan
teman, merokok pada usia muda.
PENATALAKSANAAN GANGUAN JIWA
REMAJA
Penatalaksanaan ganguan jiwa remaja
diantaranya: 1) pencegahan primer melalui
berbagai program sosial yang ditujukan untuk
menciptakan lingkungan yangmeningkatkan
kesehatan anak; 2) pencegahan sekunder dengan
menemukan kasus secara dini pada remaja yang
mengalami kesulitan di sekolah sehingga
tindakan yang tepat dapat segera dilakukan; 3)
dukungan terapeutik bagi anak-anak diberikan
melalui psikoterapi individu, konseling remaja
dan program pendidikan khusus untuk remaja
yang tidak mampu berpartisipasi dalam sistem
sekolah normal; 4) terapi keluarga dan
penyuluhan keluarga penting untuk membantu
keluarga mendapatkan ketrampilan dan bantuan
yang diperlukan guna membuat perubahan yang
dapat meningkatkan fungsi semua anggota
keluarga (Kusumawati, F, 2010).
KEPUSTAKAAN
Desmita. 2005. Psikologi Perkembangan.
Bandung: Remaja Rosda Karya.
Davdson G C. 2006. Psikologi Abnormal.
Jakarta: Raja Gravindo Persada.
Kusumawati, F. Buku Ajar Keperawatan Jiwa.
Jakarta :Salemba Medika, 2010
Tomb,D A. 2004. Buku Saku Psikiatri. Jakarta:
EGC.
Towsend, MC. 1998. Diagnosa Keperawatan
pada Keperawatan Psikiatri. Jakarta: EGC.
Iyus,I. 2007. Keperawatan Jiwa.Bandung:
Refika Aditama.
___________________ 2011. Pedoman
Kesehatan Jiwa Remaja.Dinkes Sulsel go. Id
diakses tanggal 23 Desember