A Grounded Theory Study into the Identity Development of Adolescents with Severe Mental Illness


Student thesis: Doctoral Thesis

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Awarding Institution
Award date29 Nov 2021


Severe mental illness (SMI) is characterised by severe functional impairments, which normally includes bipolar disorder, schizophrenia, and major depression. Adolescence is a unique and crucial transitionary stage from childhood to adulthood, where significant and accelerated biophysical and psychosocial development typically occurs between the ages of 10 to 19 years. Although SMI in adolescence may have lifelong impacts, no studies to date have deeply explored the identity development of adolescents with SMI.

This study aims to extend the adolescent development and mental illness evidenced base and construct a theory to explain the identity formation process of adolescents with SMI from developmental and dynamic perspectives. By using constructivist grounded theory, the data was collected through observation at three hospitals and thirty-one in-depth interviews with purposively and theoretically recruited adolescents with SMI in mainland China. The data was analysed strictly following the principles suggested by constructivist grounded theory. Four categories of personal characteristic and growth; social interaction and relationship; media representation and communication; social context and culture were developed and theoretically sensitised based on the literature.

The emergent theoretical model of Negative Identity and Enduring Identity Issue, proposes that the identity formation in adolescents with SMI is a complex developmental process, and is characterised by dynamic and multidimension. Adolescents’ identity development revolves around core concepts of having long-lasting senses of negative self and experiencing persistent SMI symptoms, predisposing the identity into five negative statuses. The negative identity is socially triggered by interactions among adolescents, parents, peers, and mental health staff, and which in turn, affect adolescents’ interpersonal relationships. The societal system either directly, or indirectly shapes the adolescents’ value system, deepens their negative identity, and prolongs identity issue through media representation and communication. The emergent theoretical model therefore explains the process by which SMI interacts with, and influences adolescents’ identity in Chinese context, highlighting the importance of negative identity as a potential early sign and symptom in adolescents with SMI.