Stakeholder perspectives of family interventions for schizophrenia in Indonesia: a qualitative study.

Mental illnesses comprise the single largest source of health-related economic burden globally and low-and middle-income countries (LMICs) are disproportionately affected. Many individuals with schizophrenia do not receive evidence-based, psychosocial interventions as these are largely unavailable, undeveloped, and under-researched in LMICs. Involving service-users and carers in the design of interventions is crucial to ensure stakeholder needs are adequately addressed by the intervention and to aid successful implementation. We aimed to explore the views and perspectives of different stakeholder groups about the delivery, format, and content of family interventions for people living with schizophrenia in Indonesia as a first step towards developing evidence-based, acceptable family interventions. This study used a qualitative design comprising single stakeholder focus groups. Data were analysed separately using the framework approach incorporating deductive and inductive coding within an existing heuristic framework. 51 participants consented to take part in this study comprising six stakeholder consultation groups including service-users (n = 15), caregivers (n = 15) and healthcare professionals (n = 21). Service users were diagnosed with schizophrenia. Caregivers comprised parents (n = 10, 67%), brothers (n = 2, 13%), sister (n = 1, 7%) and husbands (n = 2, 13%). Healthcare professionals were working as nurses (n = 6, 29%), doctors (n = 5, 23%) or cadre's (n = 10, 48%). Caregiver and service-user respondents had limited knowledge or experience of structured family interventions. There was strong support for such interventions, however, for effective delivery a number of challenges exist in terms of widespread stigmatised views, low expectations for involvement in sharing decisions about care and treatment, views that healthcare professionals are expert and have the authority to delegate tasks to families such as responsibility for ensuring medication adherence and understanding the need to balance the needs of both service-users and families when there are conflicting agendas for treatment. These findings can support the development of evidence-based family interventions for families of those with schizophrenia in Indonesia, as user-informed interventions enhance engagement, satisfaction, and adherence to family interventions.

Civic engagement and mental health system strengthening in Indonesia: a qualitative examination of the views of health professionals and national key stakeholders.

BACKGROUND: Mental health services in Indonesia are developing rapidly in response to national and global health policy to support people living with psychosis. This presents a unique opportunity for civic engagement, the active involvement of patients, carers and communities in mental health care, to shape emergent services. In-depth explorations of the views of professionals and other key stakeholders in mental health care on the use of civic engagement in Indonesia are lacking which contributes to a limited understanding of its potential in this regard. The study aimed to explore contemporary professionals' and other key stakeholders' perspectives on the current use of and potential for civic engagement to strengthen mental health systems in Indonesia. METHODS: Qualitative interviews were undertaken and analysed using thematic analysis underpinned by a critical realist approach. Eighteen multi-disciplinary professionals and lay health workers involved in mental health care in Jakarta and Bogor and 10 national key stakeholders were recruited. RESULTS: Despite high levels of awareness of and support for civic engagement amongst mental health professionals and policy makers combined with a nascent grass roots movement, analysis revealed unstructured and insufficient mechanisms for civic engagement which resulted in ad-hoc and mostly superficial levels of involvement activity. Civic engagement was thought to require a marked shift in existing practices as well as organisational and societal cultures. Challenging stigma is a key feature of civic engagement and our analysis highlights the relevance of social contact methods which are locally and culturally contextualised in this regard. Our findings point to a need to expand current definitions of civic engagement which focus on indivdiual enablement to ones that also encompass environmental and organisational enablement to optimise the future use of civic engagement in mental health settings. CONCLUSIONS: Key mental health stakeholders have identified that central aspects of Indonesian culture are well aligned to the ethos of civic engagement which has the potential to facilitate the enactment of recent global health policy. However, full realisation is likely to be impeded by prevailing paternalistic cultures in mental health services and high levels of stigma and discrimination towards those with mental illness in Indonesia without intervention.

Exploring the potential use of patient and public involvement to strengthen Indonesian mental health care for people with psychosis: A qualitative exploration of the views of service users and carers.

BACKGROUND: Patient and public involvement (PPI) has the potential to strengthen mental health systems in Indonesia and improve care for people living with psychosis. Current evidence from other parts of the world demonstrates the need to understand the contexts in which PPI is to be enacted to ensure optimal implementation. OBJECTIVE: To understand service users' and carers' views on the current use and potential applicability of PPI within Indonesian mental health services. DESIGN: Qualitative study incorporating focus groups analysed using thematic analysis. SETTING AND PARTICIPANTS: Participants included 22 service users and 21 carers recruited from two study sites in Indonesia (Jakarta and Bogor). All participants had experience of psychosis either as a service user or carer. RESULTS: Despite the value attributed to PPI in relation to improving services and promoting recovery, current use of such activities in Indonesian mental health services was limited. Participants expressed a desire for greater levels of involvement and more holistic care but felt community organizations were best placed to deliver this because PPI was considered more congruent with the ethos of third-sector organizations. Additional barriers to PPI included stigma and low levels of mental health literacy in both health services and communities. DISCUSSION AND CONCLUSION: Participants felt that there was potential value in the use of PPI within Indonesian mental health services with careful consideration of individual contexts. Future aspirations of involvement enactment should ensure a central design and delivery role for third-sector organizations. Facilitators to global collaborative research in the context of the current study are also discussed.

Cognitive behaviour therapy for anxiety in adolescent with early prodromal of psychosis at boarding school.

BACKGROUND: Early prodromal of psychosis starts in adolescent indicated by non specific symptoms which may result in the changes of behaviour, role, function, and social interaction. Cognitive behaviour therapy is a strategic intervention in reducing anxiety symptom. The purpose of this research is to find out the effects of cognitive behaviour therapy for anxiety in adolescent with early prodromal of psychosis. METHOD: The design of this research was Quasi experimental design: pre-post test with control group. Samples were selected after the screening on adolescents in boarding school with the Prodromal Questionnaire (PQ16). Subjects were 78 respondents consisting of 39 each groups, obtained by random sampling technique. Nursing intervention was provided to intervention group 1, while cognitive behaviour therapy was provided to intervention group 2. The measurement of anxiety in adolescents is by using the Hamilton Anxiety Rating Scale for Anxiety (HARS). The analysis was performed by Repeated Anova and Independent t-test. RESULT: The result of the research shows that anxiety level decrease significantly on those two groups, whilst the decrease of anxiety and early prodromal of psychosis in the intervention group 2 indicates more decrease than intervention group 1. CONCLUSION: Cognitive behaviour therapy is recommended to reduce anxiety in adolescent with early prodromal of psychosis.

Interventions Addressing Nurses' Psychological Well-being during COVID-19 Pandemic: A Systematic Review.

Objective: The study aimed to identify some interventions to improve the psychological well-being of nurses during the COVID-19 pandemic. Methods: The data used in this study are EBSCOhost, ProQuest, Taylor & Francis, Science Direct, and JSTOR. These studies were searched for available full-text articles. We used tools for risk of bias assessment, namely, the quality assessment checklist of Joanna Bright Institute tools for cross-sectional studies, cohort studies, and randomized controlled trials. Results: A total of eight studies were included in this review. The interventions in dealing with the psychosocial problems of COVID-19 nurses consisted of 2 categories: (1) interventions to prevent psychosocial problems - simulation-based teamwork training, mental health promotion strategies, and pre-examination, triage, prevention, and control of Coronavirus disease 2019 (COVID-19) evaluation training; and (2) interventions to overcome psychosocial problems experienced by COVID-19 nurses - mobile wellness programs, intervention FOREST, emotional freedom techniques, tele-counselling and mental health interventions. Conclusion: Despite limitations, we were able to perform a complete assessment of the risk of bias in included studies that provide reliable information on the studies. It is recommended that hospitals can provide interventions to improve the psychological well-being of nurses.

Culturally adapted family intervention for people with schizophrenia in Indonesia (FUSION): a development and feasibility study protocol.

BACKGROUND: Mental illnesses comprise the single largest source of health-related economic burden globally, and low- and middle-income countries are disproportionately affected. The majority of people with schizophrenia who need treatment do not receive it and are often wholly reliant on family caregivers for daily care and support. Family interventions have an exceptionally robust evidence base for their efficacy in high-resource settings, but it is unknown whether they can produce equivalent effects in some low-resource settings where cultural beliefs, explanatory models of illness and contextual socio-economic issues differ. METHODS: This protocol describes the methods for a randomised controlled trial to determine the feasibility of testing culturally adapt and refine an evidence-based, family intervention for relatives and caregivers of people with schizophrenia in Indonesia. The feasibility and acceptability of implementing our adapted, co-produced intervention via task shifting in primary care settings will be evaluated using the Medical Research Council framework for complex interventions. We will recruit 60 carer-service-user dyads and randomise them in a 1:1 ratio either to receive our manualised intervention or continue to receive treatment as usual. Healthcare workers in primary care settings will be trained to deliver family interventions using our manualised intervention by a family intervention specialist. Participants will complete the ECI, IEQ, KAST and GHQ. Service-user symptom level and relapse status will be measured using the PANSS at baseline, post-intervention and 3 months later by trained researchers. Fidelity to the intervention model will be measured using the FIPAS. Qualitative evaluation will further assist with refining the intervention, evaluating trial processes and evaluating acceptability. DISCUSSION: National healthcare policy in Indonesia supports the delivery of mental health services in a complex network of primary care centres. This study will provide important information on the feasibility of delivering family interventions for people with schizophrenia via task shifting in primary care settings in Indonesia and allow further refinement of the intervention and trial processes.

The effectiveness of mental health nursing promotive and preventive model on protective factors, risk factors and adolescents' mental health.

Adolescents are at risk in experiencing mental health problems if the risk factors owned are more than the protective factors. This study aims to identify the effectiveness of Mental Health nursing promotive and preventive models on protective factors, risk factors and Adolescents' Mental Health. This research was with quasi-experiment, design employed randomization control group pre and post-test design conducted on 240 adolescents, which was divided into both groups equally. The study found that protective factors (self-esteem, family relationship, and prosocial ability) has increased after intervention model by 10.2%; 4.4%; 15.7%, respectively, risk factors (bullying behavior, anxiety, emotional problems, behavioral problems, and peer problems) has decreased after the intervention model by 9.8%; 26.1%; 25.9%; 17.5%; 22.4%, respectively. The model also increased the adolescents' mental health after intervention model by 14.9%. The mental health nursing promotive and preventive model is effective to increase the mental health of adolescents by 21.3%. Mental health nursing' promotive and preventive model could be used as basic needs to implement early detection regarding mental health of adolescents in the UKS scope and involving teachers' role, as well as parents in maintaining mental health.

[Applying the community mental health nursing model among people with schizophrenia]. / Aplicación del modelo comunitario de enfermería de salud mental entre las personas con esquizofrenia.

OBJECTIVE: This study aimed to evaluate the application of community mental health nursing (CMHN) model using an intervention of nursing standard care and cognitive behavioral therapy on life skills and work productivity for the adult population with schizophrenia. METHOD: This study was an experimental study with an equivalent control group using randomly allocated 193 participants to either the intervention or control group at community health center in Cipayung, Jakarta. The intervention comprised in a 4-month cognitive behavioral therapy that was implemented by 33 community psychiatric nurse staff to improve the life skills and work productivity of people with schizophrenia. The instruments used to evaluate the intervention were the Indonesian version of the life skill profile (LSP) questionnaire and the work productivity and activity impairment scale (WPAI). The data analysis used a paired t-test. RESULTS: The findings show that there was a significant difference in scores on the LSP before and after the implementation in the intervention group (19.94 ± 1.27 and 38.83 ± 9.32) with p < .001 and the control group (26.93 ± 12.50 and 30.89 ± 12.41) with p = .002. The findings also show that there was a significant difference of WPAI before and after the implementation for the intervention group (2.21 ± 1.12 and 3.82 ± 1.28) with p < .05 compared with the control group (1.91 ± 1.42 and 2.19 ± 1.58) with p = .188. CONCLUSIONS: CMHN models using basic community mental health nursing interventions can be used to improve life skills and work productivity of people with schizophrenia so this could be a skill to strengthen the ability to live in the community in this type of patients.

Children's psychosocial state after the 2018 Lombok earthquake.

Background: The current earthquake disaster in Lombok, Indonesia, in July 2018 has caused 564 deaths, and 445.343 were evacuated to refugee camps, including children. Disasters have the potential in resulting short-and long-term effects on the psychological functioning, emotional adjustment, health, and developmental trajectory of children. Nurses play a significant role when a disaster occurs. One of the nurses' roles is to give a traumatic healing intervention to the victims. Objective: This study sought to assess children's psychosocial state after the 2018 Lombok earthquake. Methods: A total of 189 children from five regencies in Lombok were selected to participate in the study using accidental sampling. Data were collected using the Strengths and Difficulties Questionnaire (SDQ). Descriptive statistics and cross-tabulation were used for data analysis. Results: The participants consisted of 98 girls (51.9%) and 91 boys (48.1%), with the majority (n = 142 [75.1%]) being from school-aged children. The SDQ results showed that most of the children were at the abnormal stage for difficulties (n = 103 [54.5%]), and most of them were at a normal stage for strength (n = 97 [51.3%]). The cross-tabulation analysis revealed that gender might influence the SDQ score for the strength (p = 0.034), but not for difficulties (p = 0.482). However, age did not have a correlation with SDQ score, either for strength (p = 0.475) or difficulties (p = 0.836), respectively. Conclusion: The study found that children in Lombok generally displayed positive behavior and emotional progress after the earthquake. However, some children remained in distress and thus required more observation from parents or other social welfare agencies. This research may help nurses decide on their nursing care for children who experience disasters.

The effects of acceptance and commitment therapy on psychosocial impact and adherence of MDR-TB patients.

BACKGROUND: The Worldwide resistance prevalence of the first-line TB drug, rifampicin (RR-TB), in 2017 was 7.4 per 100,000 population, and 82% of them experienced multidrug-resistant tuberculosis (MDR-TB). Indonesia is the top 20 country with an MDR-TB burden, and its prevalence is 8.8 per 100,000 population. MDR-TB requires a long-time treatment and has accompanying side effects: biological and psychosocial effects. However, efforts to overcome the psychosocial impacts have not been conducted. This study aims to determine the effect of acceptance and commitment therapy (ACT) on anxiety, depression, suicidal ideation, and treatment adherence in MDR-TB patients. DESIGN AND METHODS: This research employed a quasi-experimental design with a pre-test three post-tests using total sampling. The pre-test was conducted before the standard nursing intervention, post-test 1 was after the standard nursing intervention, post-test 2 was after ACT session 1, and post-test 3 was after ACT session 2. Data were collected by the Hamilton Rating Scale for Anxiety (HAM-A), Beck Hopelessness Scale (BHS), a Scale for Suicide Ideation (SSI), and Morisky Medication Adherence Scale (MMAS). RESULTS: The standard nursing action and ACT reduce anxiety (p = 0.002), reduced depression (p = 0.0001), reduced suicidal ideation (p = 0.008), and increased treatment adherence (p = 0.0001). CONCLUSIONS: The standard nursing action and ACT reduce anxiety, depression, and suicidal ideation. They increase treatment adherence recommended for use in MDR-TB patients.

A contributing factor of maternal pregnancy depression in the occurrence of stunting on toddlers.

BACKGROUND:  Toddlers are a vulnerable population to nutritional problems including stunting. Stunting can have negative impact on toddlers' health. One of the factors causing stunting in toddlers is maternal pregnancy depression. This study aims to determine the relationship between maternal pregnancy depression and the incidence of stunting in toddlers. DESIGN AND METHODS:  The research design employed a descriptive correlative with quota sampling technique. The research respondents were 140 mothers of toddlers in Indonesia such as West Java, East Java, Jakarta, Yogyakarta, Bali, North Sumatra, Riau, South Kalimantan, West Kalimantan, North Sulawesi, NTT, NTB, Maluku, Papua. The data were collected by using demographic method and the Edinburgh Postpartum Depression Scale (EPDS). The statistical tests employed correlation tests. RESULTS:  The analysis reveal that 26.4% toddlers in this study are stunted and 73.6% were not stunted. Maternal pregnancy depression has a significant relationship with the incidence of stunted toddlers (p = 0.044; r = 0.170). CONCLUSIONS:  The results of this study are expected to underlie the development of mental health promotion to prevent stunted toddlers against maternal depression and preventive programs. In addition, the research is expected to underly provision of curative and rehabilitative programs for stunted toddlers.

Effectiveness health education and infant therapeutic group therapy on baby aged 0-6 months to prevent stunting risk factors: mother depression.

BACKGROUND:  Stunting is a global and national problem that can be detected at the age of 2. Therefore, before this age, promotion efforts must be conducted to prevent stunting risk factors in the future. This study aims to determine the effect of health education and infant's Therapeutic Group Therapy on stunting's risk factor: maternal postpartum depression in Indonesia. DESIGN AND METHODS:  This study employed a quasi-experimental design with a pre-test and post-test with a control group. This study employed a purposive sampling technique, with 96 respondents divided into two groups. Intervention group 1 consisted of 48 people who received health education, and group 2 consisted of 48 people who received health education and infant's Therapeutic Group Therapy. The data were collected using the Depression Inventory-II (DI II) questionnaire with a bivariate analysis of the Wilcoxon test and frequency distribution. RESULTS:  The results show that health education and infant's Therapeutic Group Therapy significantly influence the risky factors in stunting: maternal depression. It can be concluded that there were significant changes in maternal postpartum depression in intervention group 1 and intervention group 2, but in intervention group 2 who got Health Promotion and Therapeutic Group Therapy (TKT) for Infants there was a bigger and more significant decrease. CONCLUSIONS:  Nursing action, infants' Therapeutic Group Therapy, and health education are recommended to prevent risk factors for stunting: mother depression. The results of this study are expected to underlie the development of mental health promotion to prevent stunted against maternal depression and preventive programs. In addition, the research is expected to underly provision of curative and rehabilitative programs for stunted.

Applying the community mental health nursing model among people with schizophrenia.

OBJECTIVE: This study aimed to evaluate the application of community mental health nursing (CMHN) model using an intervention of nursing standard care and cognitive behavioral therapy on life skills and work productivity for the adult population with schizophrenia. METHOD: This study was an experimental study with an equivalent control group using randomly allocated 193 participants to either the intervention or control group at community health center in Cipayung, Jakarta. The intervention comprised in a 4-month cognitive behavioral therapy that was implemented by 33 community psychiatric nurse staff to improve the life skills and work productivity of people with schizophrenia. The instruments used to evaluate the intervention were the Indonesian version of the life skill profile (LSP) questionnaire and the work productivity and activity impairment scale (WPAI). The data analysis used a paired t-test. RESULTS: The findings show that there was a significant difference in scores on the LSP before and after the implementation in the intervention group (19.94±1.27 and 38.83±9.32) with p<.001 and the control group (26.93±12.50 and 30.89±12.41) with p=.002. The findings also show that there was a significant difference of WPAI before and after the implementation for the intervention group (2.21±1.12 and 3.82±1.28) with p<.05 compared with the control group (1.91±1.42 and 2.19±1.58) with p=.188. CONCLUSIONS: CMHN models using basic community mental health nursing interventions can be used to improve life skills and work productivity of people with schizophrenia so this could be a skill to strengthen the ability to live in the community in this type of patients.

Implementing civic engagement within mental health services in South East Asia: a systematic review and realist synthesis of current evidence.

INTRODUCTION: Civic engagement (CE) has the potential to transform mental health services and could be particularly important for low and middle-income countries (LMICs), which are rapidly developing to respond to the burden of poor mental health. Research from high income countries has found many challenges associated with the meaningful implementation of CE in practice, but this has been underexplored in LIMCS and in South East Asia (SEA) in particular. METHODS: We completed a realist synthesis and systematic review of peer reviewed publications and grey literature to identify the context and actions which promote successful implementation of CE approaches in SEA. We used a theory-driven approach-realist synthesis-to analyse data and develop context-mechanism-outcome configurations that can be used to explain how civic engagement approaches operate in South East Asian contexts. We worked closely with patient and public representatives to guide the review from the outset. RESULTS: Fifty-seven published and unpublished articles were included, 24 were evaluations of CE, including two Randomized Controlled Trials. The majority of CE interventions featured uptake or adaptation of Western models of care. We identified important cultural differences in the enactment of civic engagement in SEA contexts and four mechanisms which, alongside their contextual barriers and facilitators, can be used to explain how civic engagement produces a range of outcomes for people experiencing mental health problems, their families and communities. Our review illustrates how CE interventions can be successfully implemented in SEA, however Western models should be adapted to fit with local cultures and values to promote successful implementation. Barriers to implementation included distrust of services/outside agencies, stigma, paternalistic cultures, limited resource and infrastructure. CONCLUSION: Our findings provide guidance for the implementation of CE approaches within SEA contexts and identify areas for further research. Due to the collectivist nature of many SEA cultures, and the impact of shared traumas on community mental health, CE might best be implemented at community level, with a focus on relational decision making.Registration This review is registered on PROSPERO: CRD42018087841.

The fight against stigma: Multilevel stigma interventions in schizophrenia patients.

Background: Stigma is one of the main factors causing pasung (physical restraint or confinement in Indonesian terms) in schizophrenia patients. It is the main obstacle to reducing the number of pasung throughout the world. Thus, there is a need for appropriate interventions to reduce stigma in schizophrenia patients who go through pasung. This study aims to identify multilevel stigma interventions in people with schizophrenia who go through pasung (physical restraint and confinement). It can be applied and adapted to various cultural contexts. Design and Methods: Quasi-experimental research with pretest and post-test analysis consists of 82 people with schizophrenia who go through pasung. Respondents were divided into the intervention group and the control group. A multilevel stigma intervention was given to the intervention group for three months. Results: There was a significant difference in the average stigma score in the control group (moderate category stigma) and the intervention group (mild category stigma) after multilevel stigma intervention (p-value = 0.04). The average stigma score of schizophrenia patients in the intervention group decreased by 8.2%, while the average stigma score in the control group increase of 20.4%. Conclusions: Multilevel stigma interventions are effective in reducing stigma in people with schizophrenia who go through pasung. We underline that multilevel stigma interventions through collaboration from various parties can provide great opportunities in stigma reduction programs in people with schizophrenia who go through pasung.

Risk and Protective Factors of Suicidal Ideation in Adolescents.

Suicidal ideation is commonly found among adolescents. It is influenced by both risk factors (hopelessness, depression, anxiety, and stress) and protective factors (coping, social support, and self-esteem). The aim of this study was to determine the relationship between the risk and the protective factors of suicidal ideation. This was a descriptive correlative research with a cross-sectional approach that studied 207 senior high school adolescents. These adolescents filled out questionnaires related to suicidal ideation, risk factors, and protective factors. The data analyses conducted were univariate and bivariate analyses. The risk factors hopelessness, depression, anxiety, and stress are found to be associated with high suicidal ideation. This study also found that coping, social support, and self-esteem are negatively associated with suicidal ideation. The relationship between suicidal ideation and its risk and protective factors found in this study can be used to develop appropriate nursing interventions for preventing suicidal ideation in adolescents.

The Effect of Peer Leadership on Suicidal Ideation in Senior High School Teenagers.

This study aimed to determine the effect of peer leadership training on suicidal ideation in senior high school teenagers. This study followed a quasi-experimental pretest-posttest design without a control group. We obtained 43 respondents using a purposive sampling technique. An intervention was provided in the form of peer leadership training sessions. Measurements were conducted twice-once pre- and once post-intervention-using the Beck Scale for Suicidal Ideation. The analysis used was the Wilcoxon t-test. Suicidal ideation decreased significantly (p value <0.05) after peer leadership training. Providing peer leadership training could reduce suicidal ideation in adolescents from severe categories into mild ones. Peer leadership training was an effective method for reducing suicidal ideation in adolescents and should be recommended by mental health nurses for adolescents at school.

Effect of Cognitive Behavioral Therapy and Peer Leadership on Suicidal Ideation of Adolescents in Bengkulu.

To determine the effects of cognitive behavioral therapy and peer leadership on suicidal ideation among adolescents in senior high school, this study design used quasiexperimental pre-post testing with control group. Participants (N = 86) were recruited by purposive sampling technique. Data were collected using the Beck Scale for Suicide Ideation and analyzed using the Wilcoxon test, the Friedman test, and the Mann-Whitney test. The results showed that the training received by mental health nurses reduced suicidal ideation among adolescents (p < 0.05). After further cognitive behavioral therapy and peer leadership interventions, suicidal ideation decreased from the lower rate to zero (p < 0.05). A combination of the training received by mental health nurses, cognitive behavioral therapy, and peer leadership are recommended for prevention of adolescent suicidal ideation.

Promoting the Mental Health of Adolescents through Cognitive Behavior Group Therapy and Family Psychoeducation.

The aim of this study was to examine the effects of cognitive behavior group therapy (CBGT) and family psychoeducation (FPE) in promoting and maintaining adolescent mental health. This quantitative study used a quasi-experiment method, pre- and post-testing with a control group design. A total of 86 adolescents were selected using the purposive sampling method and allocated into two groups that were administered different types of intervention. The first intervention group was provided with mental health education and adolescent developmental stimulation only, which was carried out with individual exercises of stimulation. The second intervention group was provided with mental health education and adolescent developmental stimulation in addition to CBGT and FPE. A mental health continuum short-form questionnaire was used to determine mental health scores. The results showed that most of the adolescents received flourishing mental health scores. These scores significantly increased after receiving mental health education and developmental stimulation, as well as CBGT and FPE. Our results indicate that mental health education and developmental stimulation can be used to promote and maintain good mental health. CBGT and FPE can be used not only to treat mental health problems but also to promote flourishing mental health.

Risk Factors of Mental Health in Adolescents: Emotional, Behavioral, Family, and Peer Relationship Problems.

Adolescents are vulnerable to some risk factors in their lives, such as emotional and behavioral problems, problems in the family, and relationship problems within their peer group. This study aimed to describe these risk factors in adolescents. This study used a descriptive statistic design with a cross-sectional approach. The study sample consisted of 292 students in the 8th grade at a junior high school, selected through a purposive sampling technique. The adolescents experienced emotional and behavioral problems, as well as relationship problems with their peers, which within the study was categorized as normal, while problems in the family have the borderline score. It is essential to promote mental health in adolescents in order to maintain good emotional conditions and behaviors, as well as good relationships within their peer group. In the meantime, mental health promotion programs should be given to adolescents and their families to prevent problems among adolescents that will affect their mental health condition.