# data[].attributes.headline
The importance of the issue with relevant and recent statistics 

# data[].attributes.subject
The importance of the issue with relevant and recent statistics 

# data[].attributes.body
Mental health illnesses are a leading cause of health-related disabilities in Children and young people and can have adverse and long-lasting effects.

can lead to -
poor educational attainment
interpersonal difficulties
emotional distress
self harm and suicide
eating disorders

# data[].attributes.headline
Factors in school affecting mental health: 

# data[].attributes.subject
Factors in school affecting mental health: 

# data[].attributes.body
bullying
discrimination
deviant peer influences
peer pressure
poor teacher to pupil relationships

# data[].attributes.body
10% of children between 5-16 years suffer a clinically significant mental health issue.
Boys aged 11-15 years are 1.3x more likely to suffer a mental health illness than girls.
12% of young people live with the problem - mental health affecting physical health

# data[].attributes.body
695,000 have a clinically significant mental illness.
39,500 suffer from anxiety
10,800 suffer from depression
18,900 have ADHD (affects 1.5% of children)
68,100 conduct disorder (defiance, aggression and anti-social behaviour)

# data[].attributes.body
Implement SEL throughout a school day and use a multi-tiered system of support and professional development

Teach skills on social and emotional skills.

Keep in frequent touch with parents.

# data[].attributes.attachment_link.description
Coram Campus, 41 Brunswick Square, London WC1N 1AZ. The PSHE Association is a registered charity and a company limited by guarantee. Charity number: 1127056 Company number: 6551975 © Copyright 2021 PSHE Association All Rights Reserved.

# data[].attributes.headline
Who schools and teachers can enlist help from:

# data[].attributes.subject
Who schools and teachers can enlist help from:

# data[].attributes.body
Child and youth workers
School councillors
Social workers

# data[].attributes.headline
Research teaching strategies which may be implemented to address the issue or topic.

# data[].attributes.subject
Research teaching strategies which may be implemented to address the issue or topic.

# data[].attributes.attachment_link.readable_text
* Be a caring adult and develop positive rapport with students.

* Be empathic and non-judgemental.

* Directly teach lessons on social and emotional skills.

* Work to reduce stigma of mental health issues with all students.

* Identify students who need increased support and communicate them to the school team.

* Involve community supports for whole class presentations.

* Be in frequent contact with parents, administration and other teachers.

* Enlist school counseling supports (Child and Youth Worker, Social Worker, Counselor, etc.).

* Be aware of increased risk taking behaviours and report to parents and school team.

* In a private setting, discuss your concerns with the students in a supportive and non-punitive way. Ask the student for ways that you can help.

* Consider the development of an IEP with Accommodations for any instructional, environmental and/or assessment accommodations that may be helpful to reduce stress and support positive mental health for the student.

* Provide resources to the student and parent on counseling options (school and/or community).

* Provide choices in activities and use differentiated instruction.

* Provide opportunities for success and rewards for pro-social behaviours.

# data[].attributes.attachment_link.description
Be a caring adult and develop positive rapport with students. * Be empathic and non-judgemental. * Directly teach lessons on social and emotional skills. * Work to reduce stigma of mental health issues with all students. * Identify students who need increased support and communicate them to the school team.

# data[].attributes.headline
Theories that can be applied to Mental Health

# data[].attributes.subject
Theories that can be applied to Mental Health

# data[].attributes.body
- Believes personality is developed through a series of stages.
- Erikson believed people experience a conflict that serves as a turning point in development.
- Conflicts are centered on development of psychological quality. During these times, the potential for personal growth is high but so is the potential for failure.

Social anxieties could surface through conflict and self-esteem could be in affect.

Ego strength can be promoted through professional development, curricula, and research, as well as activities that support the essential strengths of core skills.

# data[].attributes.body
Growth mindset is a theory which suggests that you can improve intelligence, ability and performance and that these are not set in stone.

# data[].attributes.attachment_link.readable_text
Abstract

Ego integrity and despair form one of the fascinating conceptual pairs that Erik Erikson coined in his theory of human development across the life span. In contrast to identity versus role confusion ( Kroger, 2007) or generativity versus stagnation ( McAdams, 2009), it has not been the subject of intensive empirical research. Existing studies have mainly been carried out in the Eriksonian tradition, relating ego integrity and despair to the resolution of earlier psychosocial crises, to the acceptance of the past and the finitude of life. The present study addresses ego integrity and despair from recent theories of personality and mental health to bring it closer to contemporary psychology. We use a cross-sectional study of Dutch adults in their second half of life (50-95 years) to assess hypotheses derived from this broader framework. We are especially interested how ego integrity and despair are related to more stable dispositional traits as well as to mental health as a more momentary and fluctuating state.

Erikson (1950, 1982) distinguished eight phases in his model of life-span development, each of which is characterized by a particular psychosocial issue. The last phase of life is characterized by the duality of ego integrity versus despair. Erikson described ego integrity as "the acceptance of one's one and only life cycle as something that had to be" (1950, p. 268) and later as "a sense of coherence and wholeness" (1982, p. 65). At the same time, late life brings reasons for experiencing despair, such as aspects of the past, present, and future that are difficult to integrate into a meaningful whole. Late life is therefore characterized by both integrity and despair as alternating states that need to be balanced.

In Erikson's model, ego integrity is achieved through a process of reminiscence about one's past that contributes to wisdom and death acceptance. Cross-sectional studies found that reminiscing about the past is related to ego integrity ( Santor & Zuroff, 1994; Taft & Nehrke, 1990). The resolution of regret about the past has both a cross-sectional and longitudinal relation to ego integrity ( Torges et al., 2008, 2009). Studies also found a moderate negative relation between ego integrity and death anxiety ( Hui & Coleman, 2013) as well as a positive relation to wisdom ( Webster, 2010).

To conclude, existing studies have shown systematic relations fitting Erikson's life-span theory: the sequence of resolutions of dilemmas in adult development, reminiscence, and death acceptance. Ego integrity and despair might thus be seen as important indicators of life-span development. In the present study, we add to these insights by studying ego integrity and despair in relation to personality traits and mental health.

There is a dearth of studies relating ego integrity and despair to personality traits. Personality traits, such as neuroticism, extraversion, or openness to experience, are conceptualized as rather stable dispositions to feel, think, and act in certain ways ( McCrae & Costa, 1986; Denissen, van Aken, & Roberts, 2011). Although it is recognized that changes across the life span may initiate changes in personality traits, the personality perspective basically treats individual differences in adaptation and growth across the life span as the result of rather stable traits. Hence, personality traits might be related to life-span developmental indicators such as ego integrity and despair.

To summarize, we test the following hypotheses:

(1) Neuroticism is related to despair and extraversion and openness to experience to ego integrity.

(2) Depressive symptoms are related to despair and well-being to ego integrity.

(3) Depressive symptoms mediate the relation between neuroticism and despair, whereas well-being mediates the relation of extraversion and openness to ego integrity.

Method

Participants

In the present study, 218 Dutch adults aged between 50 and 95 years participated. These adults were recruited by first-year psychology students who were enrolled in an introductory course on personality psychology at the University of Twente, the Netherlands. Students got course credits to recruit one or two persons older than the age of 50 years in their own social network. Most students asked a grandparent (45%) or a parent (44%) to participate, but some asked other relatives (5%), neighbors (3%), or acquaintances (3%).

Table 1 shows that the sample is rather diverse in age, gender, educational level, and marital status. Participants were between 50 and 95 years old with a mean of 67 years ( SD = 13.0). A majority is women and most participants are married. Almost half of the participants had 10 years of education or less.

Instruments

Participants filled out a questionnaire with different instruments using Survey Monkey. Respondents had to answer all items of an instrument before proceeding with the next instrument, so there were no missing values.

Ego integrity was measured with the Northwestern Ego Integrity Scale (NEIS; Janis, Canak, Machado, Green, & McAdams, 2011). This 15-item scale was translated into Dutch and backwards into English to obtain a Dutch version that is equivalent to the English one. The scree plot in an exploratory factor analysis suggested that the NEIS is a two-dimensional scale. Nine items loaded higher than .50 on one of both dimensions. We used these items in a confirmatory factor analysis (LISREL 9.10). We found that a structure with two unrelated factors fitted the data well (χ ²(26) = 55.7, p = .001; RMSEA = .072, p(RMSEA<.05) = .078; SRMR = .055; CFI = .95; GFI = .95; AGFI = .91) and significantly better than a one factor solution (Δχ ²(18) = 193.4; p > .05). We also assessed factorial invariance between the younger age group (50-64 years; n = 100) and the older age group (65-95 years; n = 118). The fit of the model that constrained the factor loadings and item error variances to be identical had a similar fit as the model that leaves these parameters free (Δχ ²(18) = 24.029, p > .05; ΔCFI = .01; ΔRMSEA = 0.003, p > .05; Cheung & Rensvold, 2002). Hence, items have the same quality as measures of ego integrity and despair for both age groups. The completely standardized solution for the total group is given in Table 2. The internal consistency is satisfactory (Cronbach alpha is .74 for ego integrity and .75 for despair).

Three personality traits (neuroticism, extraversion, and openness to experience) are measured with the Dutch version of the NEO-FFI ( Hoekstra, Ormel, & de Fruyt, 1996). The internal consistency (Cronbach alpha) of the subscales in this sample was .86 for neuroticism, .75 for extraversion, and .76 for openness to experience.

Well-being was measured using the Mental Health Continuum-Short Form ( Keyes et al., 2008), a reliable and well-validated instrument in the Netherlands ( Lamers, Westerhof, Bohlmeijer, ten Klooster, & Keyes, 2011). The scale covers emotional well-being (3 items, e.g., "In the past month, how often did you feel satisfied"), social well-being (5 items, e.g., "In the past month, how often did you feel that you had something important to contribute to society"), and psychological well-being (6 items, e.g., "Good at managing the responsibilities of your daily life"). Each item represents a theoretically validated feeling of well-being, of which the frequency in the last month is rated (0 = never to 5 = every day). We used the mean score across the 14 items, a higher score indicates a better well-being. The scale had a good reliability in the present sample (Cronbach alpha = .88).

Depressive symptoms were assessed with the brief Center for Epidemiological Studies Depression scale ( Cole, Rabin, Smith, & Kaufman, 2004; Haringsma, Engels, Beekman, & Spinhoven, 2004). The scale is highly reliable in our sample (Cronbach alpha = .83).

Participants also completed a brief demographic questionnaire assessing age, gender, marital status, and education ( Table 1).

Results

The second hypothesis was that depressive symptoms have a relation to despair and well-being to ego integrity. The bivariate relations ( Table 3) show that more depressive symptoms are significantly related to more despair but not to ego integrity. More well-being has a significant relation to more ego integrity but not to despair. As well-being and depressive symptoms hold a relation as well ( r = −.44; Table 3), we also assessed the partial correlations, controlling for the complementary continuum. Again, we found that depressive symptoms are related to despair (partial r = .32, p < .001) but not to ego integrity (partial r = .05, p = .215) when controlling for well-being. Well-being remains related to ego integrity (partial r = .37; p < .001) but not to despair (partial r = .09; p = .200). These findings support the second hypothesis.

The third hypothesis was that depressive symptoms mediate the relation between neuroticism and despair, whereas well-being mediates the relation of extraversion and openness to ego integrity. We first added well-being and depressive symptoms to the regression model in Table 4. The relation of depressive symptoms to despair is no longer significant when controlling for personality traits. Well-being still holds a relation to ego integrity. We did mediating analyses with the SPSS macro "mediate" ( Preacher & Hayes, 2004), using bootstrapping procedures ( n = 5,000 bootstrap resamples) in order to assess the indirect relation of personality traits through well-being and depressive symptoms. Neuroticism did not have a significant indirect relation to despair through depressive symptoms ( r = −.02; 95% confidence interval (CI) = −.05 to .18). Extraversion had an indirect relation to ego integrity through well-being ( r = .22; 95% CI = .12−.36). Openness to experience also had a significant indirect relation to ego integrity through well-being ( r = .12; 95% CI = .04-.24). None of the other indirect relations of the three personality traits to despair and ego integrity through depressive symptoms and well-being was significant. These findings support the hypothesis for ego integrity but not for despair.

As the age range of the sample was broad, we also assessed whether age moderates the relations of personality traits and well-being and depressive symptoms to ego integrity and despair. We therefore added interactions of age as a continuous variable with all other variables (demographic characteristics, personality traits, and well-being and depressive symptoms). As five moderating tests were conducted for each dependent variable (three for personality traits and two for well-being and depressive symptoms), we applied a Bonferroni correction and used p < .01 instead of p < .05 as significance level. Age did not significantly moderate the relations of the other variables to ego integrity or despair. The findings regarding the relations of personality traits and well-being and depressive symptoms to ego integrity and despair thus apply for people with different chronological ages in their second half of life.

Discussion

Previous studies in the Eriksonian tradition have shown that ego integrity and despair are important characteristics in later life that are related to the resolution of previous dilemmas, reminiscence, and death acceptance. The present study is the first to take a broader perspective of personality and mental health to the study of ego integrity and despair. Extraversion and openness to experience had an indirect relation to ego integrity that was mediated by well-being. Neuroticism was related to despair and explained the relationship between depressive symptoms and despair.

Previous studies showed that ego integrity and despair do not hold strong relations to age ( Hannah et al., 1996; Ryff & Heincke, 1983; Webster, 2003; see however, Domino & Affonso, 1990). We also found that chronological age is unrelated to ego integrity and despair. Age also did not moderate the relations of ego integrity and despair to personality traits and well-being and depressive symptoms. Last, indirect and direct relations of ego integrity and despair to rather stable personality traits were found. Taken together, these findings suggest that ego integrity and despair might be more a question of individual personality traits than of chronological age.

There are some limitations to our study. First of all, like almost all studies on ego integrity and despair, it had a cross-sectional design. Only longitudinal studies can clarify how personality traits, the two continua of mental health, and ego integrity and despair are related across time. Second, students recruited an ad hoc sample that consisted mainly of close relatives. The sample contains an overrepresentation of women and higher educated participants in comparison with the Dutch population. As gender and education played a minor role in the regression analyses, this selective effect will not be strong. Although we reached a diverse group of participants, the recruitment strategy might result in a more homogeneous sample. For example, this might account for the lack of age differences. It would therefore be interesting to test the hypotheses in a more representative survey as well as in more specific samples, like people who are confronted with death by an incurable disease. Third, we only assessed three out of the big five of personality traits and only depressive symptoms as a measure of mental illness. Further studies should address whether other traits such as agreeableness and conscientiousness, as well as other aspects of mental illness such as anxiety, hold similar relations to ego integrity and despair. Last, we did not add measures for the resolution of other psychosocial crises such as generativity versus stagnation or identity versus role confusion. Other studies in the Eriksonian tradition did not only find that ego integrity is related more to the resolution of previous crises than to chronological age (e.g., James & Zarrett, 2005; Torges et al., 2008). They also suggest that other dualities, such as identity versus role confusion, are not just important in adolescence but refer to a continuous process of consolidation and revision in relation to age-graded life contexts ( Kroger, 2007; Westerhof, 2010; Whitbourne, 1986). Adding measures for other crises would make it possible to better demonstrate the added value of also adding personality traits and mental health variables to the Eriksonian model. Despite these limitations, we conclude that our study sheds new light on ego integrity and despair from contemporary models of personality and mental health.

References

Author notes

# data[].attributes.attachment_link.title
Relation of Ego Integrity and Despair to Personality Traits and Mental Health

# data[].attributes.attachment_link.description
Ego integrity and despair form one of the fascinating conceptual pairs that Erik Erikson coined in his theory of human development across the life span. In contrast to identity versus role confusion ( Kroger, 2007) or generativity versus stagnation ( McAdams, 2009), it has not been the subject of intensive empirical research.