Mental health and wellbeing among adolescents in Scotland: profile and trends

Executive Summary

Introduction and background

The Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) is a continuation of a long established series of national surveys on smoking, drinking and drug use. It is the Scottish Government's main source of prevalence data on adolescent substance use. The data on substance use is collected alongside other contextual lifestyle, health and social factors.

This report explores trends in mental health and wellbeing and explores the factors which best predict higher and lower mental health and wellbeing. All differences commented on in the report are statistically significant.

Changes in mental health and wellbeing over time

The 'Strengths and Difficulties Questionnaire' (SDQ) has been included in SALSUS since 2006. This is a standard measure of mental health and wellbeing and gives a measure of overall mental health and wellbeing along with scores for five separate scales. The 5 scales cover emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and pro-social behaviour.

Overall SDQ scores have remained fairly constant over time among young people in Scotland. However, once this is broken down by individual SDQ scales, the picture becomes more complicated.

Fewer young people have conduct problems in 2013 compared to 2006 and, similarly, pro-social behaviour has been improving gradually since 2006. There has also been a small decrease in hyperactivity. In contrast, emotional problems, and to a lesser extent peer problems, have worsened over time, with the main change happening between 2010 and 2013.

One of the most important findings is the striking difference in results for 15 year old girls in the last 3 years when compared with the other demographics groups. This group appear to be suffering much poorer mental health and wellbeing than the other groups, particularly in relation to emotional problems - borderline and abnormal scores rose from 28% in 2010 to 41% in 2013^[1].

In terms of overall mental health and wellbeing, in 2013, 39% of 15 year old girls were abnormal/borderline on the SDQ scale. In 2010, the corresponding figure was 29%. This difference is statistically significant.

Since 2010, SALSUS has also included the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). This is a standard tool that measures mental well-being based on responses to 14 statements. WEMWBS scores have remained reasonably stable between 2010 and 2013. However, there was a slight decrease in the average mental wellbeing score among 15 year olds girls.

Two other surveys show similar findings. The Scottish Health Survey and the Scottish element of the cross-national Health Behaviour in School-aged Children (HBSC) Study also both find that mental health and wellbeing deteriorates with age and girls have worse mental health and wellbeing than boys.

Profile of mental health and wellbeing in 2013

Many factors showed an association with emotional and behavioural problems and, in most cases, an inverse relationship with mental health and wellbeing. However, there were two main areas that emerged as key to pupils' mental health and wellbeing:

• The number and nature of pupils' friendships - those who had fewer friends had poorer mental health and wellbeing e.g. 75% of girls with no close friends had a borderline or abnormal overall SDQ score, as did those with older friends e.g. 17% of pupils who had friends their own age had a borderline or abnormal conduct problems score compared with 41% of pupils with mostly older friends.
• The pupils' relationship with school - those that disliked school, felt pressured by school work, truanted on multiple occasions or had been excluded had poorer mental health and wellbeing than those that did not.

Other factors that were associated with increased prevalence of poor mental health and wellbeing included:

• Mother's knowledge of activity being below average
• Spending 6-7 nights a week out with friends.

Variables that were linked to better mental health and wellbeing included:

• Living with both parents
• Expecting to go to university after leaving school
• Belonging to a group or club.

A number of activities appeared to have a protective effect against poor mental health and wellbeing (although causal links are likely to be complex). Belonging to a group or club and seeing friends, doing a hobby, reading books or playing a sport at least weekly were associated with better mental health and wellbeing. For girls in particular, playing sport on a weekly basis was strongly related to lower levels of emotional and behavioural problems.

Predictors of mental health and wellbeing

Girls were more likely than boys to have borderline or abnormal scores for the overall SDQ scale, emotional problems and hyperactivity. However, boys were more likely than girls to have problems with conduct, peers or pro-social behaviour.

The relationship between age and mental health and wellbeing is not straightforward. Emotional and behavioural problems appeared to increase, while mental health and wellbeing decreased, as pupils moved further into adolescence.

Overall, poor mental health and wellbeing is more prevalent among S4 than S2 pupils. However, age did not come out as a significant factor in the modelling of the overall SDQ score. Age, by itself, is not a key driver of mental health and wellbeing. Instead, it reflects the prevalence of other drivers changing as pupils get older. Most notably, S4 pupils are more likely than S2 pupils to feel pressurised by schoolwork and to not like school.

Poorer physical health is associated with lower mental health and wellbeing. Pupils who reported that they had a limiting illness or disability tended to suffer from poorer mental health and wellbeing.

Pupils who had a mixed or multiple ethnicity were more likely to suffer from poor mental health and wellbeing than those from other ethnicities.

Higher levels of deprivation were correlated with poorer mental health and wellbeing. The Scottish Index of Multiple Deprivation (SIMD), perceived family affluence, and receipt of Free School Meals all showed a relationship with mental health and wellbeing. Perceived family affluence had a stronger association than the geography based measure of deprivation (SIMD) and receipt of Free School Meals.

However, the impact of deprivation was not as large as some other factors such as attitudes to school. Pupils who thought that their family was not well off were twice as likely as those who thought that their family was very or quite well off to have borderline or abnormal scores for the overall SDQ. Pupils in the most deprived quintile of SIMD were 50% more likely than those in the least deprived quintile to have borderline or abnormal scores for the overall SDQ. In contrast, pupils who said that they did not like school were over four times more likely to have borderline or abnormal scores than those who said that they liked school a lot.

There was no clear pattern in mental health and wellbeing by urban/rural classification.