Skip to main content

How social context impacts on the development, identification and treatment of mental and substance use disorders among young people – a qualitative study of health care workers

  • D. Leahy (a1), E. Schaffalitzky (a1), C. Armstrong (a1), L. Latham (a2), F. McNicholas (a3), D. Meagher (a1), Y. Nathan (a1), R. O’Connor (a1), V. O’Keane (a4), P. Ryan (a5), B. P. Smyth (a6), D. Swan (a1) and W. Cullen (a3)...

Social context has a major influence on the detection and treatment of youth mental and substance use disorders in socioeconomically disadvantaged urban areas, particularly where gang culture, community violence, normalisation of drug use and repetitive maladaptive family structures prevail. This paper aims to examine how social context influences the development, identification and treatment of youth mental and substance use disorders in socioeconomically disadvantaged urban areas from the perspectives of health care workers.


Semi-structured interviews were conducted with health care workers (n=37) from clinical settings including: primary care, secondary care and community agencies and analysed thematically using Bronfenbrenner’s Ecological Theory to guide analysis.


Health care workers’ engagement with young people was influenced by the multilevel ecological systems within the individual’s social context which included: the young person’s immediate environment/‘microsystem’ (e.g., family relationships), personal relationships in the ‘mesosystem’ (e.g., peer and school relationships), external factors in the young person’s local area context/‘exosystem’ (e.g., drug culture and criminality) and wider societal aspects in the ‘macrosystem’ (e.g., mental health policy, health care inequalities and stigma).


In socioeconomically disadvantaged urban areas, social context, specifically the micro-, meso-, exo-, and macro-system impact both on the young person’s experience of mental health or substance use problems and services, which endeavour to address these problems. Interventions that effectively identify and treat these problems should reflect the additional challenges posed by such settings.

Corresponding author
*Address for correspondence: Professor W. Cullen, UCD School of Medicine & Medical Science, Belfield, Dublin 4, Ireland. (Email:
Hide All
Andreas, JB, O’Farrell, TJ, Fals-Stewart, W (2006). Does individual treatment for alcoholic fathers benefit their children? A longitudinal assessment. Journal of Consulting and Clinical Psychology 74, 191198.
Barnes, GE, Mitic, W, Leadbeater, B, Dhami, MK (2009). Risk and protective factors for adolescent substance use and mental health symptoms. Canadian Journal of Community Mental Health (Revue canadienne de santé mentale communautaire) 28, 115.
Barry, MM, Clarke, AM, Jenkins, R, Patel, V (2013). A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC Public Health 13, 835.
Baudelot, C, Establet, R (2008). Suicide: The Hidden Side of Modernity. Polity Press: Cambridge.
Biddle, L, Gunnell, D, Sharp, D, Donovan, JL (2004). Factors influencing help seeking in mentally distressed young adults: a cross-sectional survey. British Journal of General Practice 54, 248253.
Bodenheimer, T, Wagner, EH, Grumbach, K (2002). Improving primary care for patients with chronic illness. Journal of the American Medical Association 288, 17751779.
Bonomo, YA, Bowes, G (2001). Putting harm reduction into an adolescent context. Journal of Paediatrics and Child Health 37, 58.
Braun, V, Clarke, V (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77101.
Bronfenbrenner, U (1979). Ecology of Human Development. Harvard University Press: Cambridge, MA.
Bronfenbrenner, U (1989). Ecological systems theory. Annals of Child Development 6, 185246.
Bronfenbrenner, U (2005). Making Human Beings Human: Bio-Ecological Perspectives on Human Development. Sage: Thousand Oaks, CA.
Cannon, M, Coughlan, H, Clarke, M, Harley, M, Kelliher, I (2013). The Mental Health of Young People in Ireland: A Report of the Psychiatric Epidemiology Research across the Lifespan (PERL) Group. RCSI: Dublin. ( Accessed 24 October 2013.
Chew-Graham, C, Mullin, S, May, CR, Hedley, S, Cole, H (2002). Managing depression in primary care: another example of the inverse care law? Family Practice 19, 632637.
Cleary, A, Nixon, E, Fitzgerald, M (2007). Psychological health and well-being among young Irish adults. Irish Journal of Psychological Medicine 24, 139144.
Connell, RW (2005). Growing up masculine: rethinking the significance of adolescence in the making of masculinities. Irish Journal of Sociology 14, 1128.
Coughlan, H, Cannon, M, Shiers, D, Power, P, Barry, C, Bates, T, Birchwood, M, Buckley, S, Chambers, D, Davidson, S, Duffy, M, Gavin, B, Healy, C, Healy, C, Keeley, H, Maher, D, Tanti, C, McGorry, P (2013). Towards a new paradigm of care: the international declaration on youth mental health. Early Intervention in Psychiatry 7, 103108.
Crum, RM, Ensminger, ME, Ro, MJ, McCord, J (1998). The association of educational achievement and school dropout with risk of alcoholism: a twenty-five year prospective study of inner-city children. Journal of Studies on Alcohol 59, 318326.
Cuijpers, P (2003). Three decades of drug prevention research. Drugs: Education, Prevention, and Policy 10, 720.
Cullen, W, Broderick, N, Connolly, D, Meagher, D (2012). What is the role of general practice in addressing youth mental health? A discussion paper. Irish Journal of Medical Science 181, 189197.
Cullen, W, O'Brien, S, O'Carroll, A, O'Kelly, FD, Bury, G (2009). Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care. BMC Family Practice 10, 25, doi:1471-2296-10-25.
Dooley, B, Fitzgerald, A (2012). My World Survey. National Study of Youth Mental Health in Ireland ( Accessed 4 August 2012.
Edokpolo, O, James, P, Kearns, C, Campbell, A, Smyth, BP (2010). Gender differences in psychiatric symptomatology in adolescents attending a community drug and alcohol treatment program. Journal of Psychoactive Drugs 42, 3136.
Expert Group on Mental Health Policy (2006). A Vision for Change – Report of the Expert Group on Mental Health Policy. Government of Ireland: Dublin ( Accessed 7 February 2011.
Fitzgerald, M (2001). Psychopharmacological treatment of adolescent and adult attention deficit hyperactivity disorder. Irish Journal of Psychological Medicine 18, 9398.
Hart, JT (1971). The Inverse Care Law. Lancet 1, 405412.
Hastings, A (2004). Stigma and social housing estates: beyond pathological explanations. Journal of Housing and the Built Environment 19, 233254.
Healy, D, Naqvi, S, Meagher, D, Cullen, W, Dunne, C (2012). Primary care support for youth mental health: a preliminary evidence base for Ireland’s Mid-West. Irish Journal of Medical Science 182, 237243.
Houston, K, Hawton, K, Shepperd, R (2001). Suicide in young people aged 15-24: a psychological autopsy study. Journal of Affective Disorders 63 ((1-3) 159170.
Igra, V, Irwin, CE (1996). Theories of adolescent risk-taking behaviour. In Handbook of Adolescent Health Risk Behaviour (ed. R. J. DiClemente, W. B. Hansen, L.E. Ponton), pp. 3551. Plenum Press: New York.
Iliffe, S, Gledhill, J, da Cunha, F (2004). The recognition of adolescent depression in general practice: issues in the acquisition of new skills. Primary Care Psychiatry 9, 5156.
Illback, RJ, Bates, T (2011). Transforming youth mental health services and supports in Ireland. Early Intervention in Psychiatry 5, 2227.
Kalff, A, Kroes, M, Vles, JSH, Hendrisken, JGM, Feron, JM, Steyaert, J, van Zeben, TMCB, Jolles, J, van os, J (2001). Neighbourhood level and individual level SES effects on child problem behaviour: a multilevel analysis. Journal of Epidemiology and Community Health 55, 246250.
Kataoka, SH, Zhang, L, Wells, KB (2002). Unmet need for mental health care among US children: variation by ethnicity and insurance status. American Journal of Psychiatry 159, 15481555.
Kelly, BD (2007). The Irish Mental Health Act 2001. Psychiatric Bulletin 31, 2124.
L’Abate, L (1990). Building Family Competence. Sage: Newbury Park, CA.
Leahy, D, Schaffalitzky, E, Armstrong, C, Bury, G, Davis, R, Cussen-Murphy, P, Davis, R, Dooley, B, Gavin, B, Keane, R, Keenan, E, Latham, L, Meagher, D, McGorry, P, McNicholas, F, O'Connor, R, O'Dea, E, O'Keane, V, O'Toole, TP, Reilly, E, Ryan, P, Sanci, L, Smyth, BP, Cullen, W (2013). Primary care and youth mental health in Ireland: qualitative study in deprived urban areas. BMC Family Practice 14, 194.
MacGabhann, L, Scheele, A, Dunne, T (2004). Mental health and addiction services and the management of dual diagnosis in Ireland: National Advisory Committee on Drugs (NACD), Government Public Sales Office, Dublin.
Mathers, CD, Loncar, D (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine 3, e442.
McGorry, PD (2005). ‘Every me and every you’: responding to the hidden challenge of mental illness in Australia. Australian Psychology 13, 315.
McGorry, PD, Purcell, R, Hickie, IB, Jorm, AF (2007). Investing in youth mental health is a best buy. Medical Journal of Australia 187, S5S7.
McMahon, EM, Reulbach, U, Corcoran, P, Keeley, HS, Perry, JI, Arensman, E (2010). Factors associated with deliberate self-harm among Irish adolescents. Psychological Medicine 40, 18111819.
Mendelson, T, Turner, A, Tandon, SD (2010). Violence exposure and depressive symptoms among adolescents and young adults disconnected from school and work. Journal of Community Psychology 38, 607621.
Middleton, N, Sterne, JA, Gunnell, D (2006). The geography of despair among 15-44 year old men in England and Wales: putting suicide on the map. Journal of Epidemiology and Community Health 60, 10401047.
Murry, VM, Heflinger, CA, Suiter, SV, Brody, GH (2011). Examining perceptions about mental health care and help-seeking among rural African American families of adolescents. Journal of Youth and Adolescence 40, 11181131.
O’Kelly, C, Cullen, W, O’Kelly, S, O’Kelly, F, Bury, G (2010). A primary care-based health needs assessment in inner city Dublin. Irish Journal of Medical Science 179, 399403.
Patel, V, Flisher, AJ, Hetrick, S, McGorry, P (2007). Mental health of young people: a global public-health challenge. Lancet 369, 13021313.
Patterson, CJ, Kupersmidt, JB, Vaden, NA (1990). Income level, gender, ethnicity and household composition as predictors of children’s’ school‐based competence. Child Development 61, 485494.
Quane, JM, Rankin, BH (1998). Neighbourhood poverty, family characteristics and commitment to mainstream goals: the case of African American adolescents in the inner city. Journal of Family Issues 19, 769794.
Sawyer, SM, Afifi, RA, Bearinger, LH, Blakemore, SJ, Dick, B, Ezeh, AC, Patton, GC (2012). Adolescence: a foundation for future health. Lancet 379, 16301640.
Simons-Morton, B, Chen, R (2005). Latent growth curve analyses for parent influence on drinking progression among early adolescents. Journal of Studies on Alcohol 66, 513.
Stevenson, C, McNamara, N, Muldoon, O (2014). Stigmatised identity and service usage in disadvantaged communities: residents’, community workers’ and service providers’ perspectives. Journal of Community & Applied Social Psychology 24, 453466.
Stirling, A, Wilson, P, McConnachie, A (2001). Deprivation, psychological distress and consultation length in general practice. British Journal of General Practice 51, 456460.
Sturm, R, Ringel, JS, Andreyeva, T (2003). Geographic disparities in children’s mental health care. Pediatrics 112, e308e308.
Swick, KJ, Williams, RD (2006). An analysis of Bronfenbrenner’s bio-ecological perspective for early childhood educators: implications for working with families experiencing stress. Early Childhood Education Journal 33, 371378.
Syed, H, Masaud, TM, Nkire, N, Iro, C, Garland, MR (2010). Estimating the prevalence of adult ADHD in the psychiatric clinic: a cross-sectional study using the adult ADHD self-report scale (ASRS). Irish Journal of Psychological Medicine 27, 195197.
Ungar, M, Ghazinour, M, Richter, J (2013). Annual research review: what is resilience within the social ecology of human development? Journal of Child Psychology and Psychiatry 54, 348366.
Van Hout, MC, Foley, M (2013). Attention-deficit hyperactivity disorder (ADHD) in adults attending addiction treatment in Ireland: preliminary international ADHD in substance-use disorders prevalence study (IASP) results. Irish Journal of Psychological Medicine 30, 171177.
Velleman, RD, Templeton, LJ, Copello, AG (2005). The role of the family in preventing and intervening with substance use and misuse: a comprehensive review of family interventions with a focus on young people. Drug and Alcohol Review 24, 93109.
Wasserman, C, Hoven, CW, Wasserman, D, Carli, V, Sarchiapone, M, Al-Halabí, S, Apter, S, Balazs, J, Bobes, J, Cosman, D (2012). Suicide prevention for youth – a mental health awareness program: lessons learned from the Saving and Empowering Young Lives in Europe (SEYLE) intervention study. BMC Public Health 12, 776.
Wilkinson, RG, Marmot, MG (2003). Social Determinants of Health: The Solid Facts, 2nd edn.. WHO Regional Office for Europe: Copenhagen, Denmark.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Irish Journal of Psychological Medicine
  • ISSN: 0790-9667
  • EISSN: 2051-6967
  • URL: /core/journals/irish-journal-of-psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score