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

1 Background and methodology

Policy background

The Scottish Government's Mental Health Strategy 2012-2015 outlines mental health policy for children and young people across several priority areas. It takes forward action points from the preceding 'Delivering for Mental Health 2006' and 'Towards a Mentally Flourishing Scotland: Policy and Action Plan 2009-2011'.

Policy in this area aims to develop child and adolescent mental health services that are directed at the care needs of this group. For example, the strategy addresses the specific mental health care needs of children and young people by setting out policy on attachment issues and by making basic mental health training more widely available to professionals in the children's services workforce and improving access to child psychotherapy by investing in a new cohort of trainees.

The Mental Health Strategy is informed by national indicators for child and adolescent mental health (2012) developed by the Scottish Government and NHS Scotland. The national indicators cover mental health problems, mental wellbeing and associated contextual factors such as learning and development and equality. The indicators are aligned with other initiatives directed towards the wellbeing of children and young people such as the Early Years Framework, Curriculum for Excellence, Equally Well and Getting it Right for Every Child.

The Scottish Government is working alongside a range of stakeholders to develop a children and adolescent mental health services scorecard to collect data on the provision of mental health care for children with learning disabilities, and identify areas where there is limited access to care, in order to base targeted interventions. The strategy details targets to improve accessibility of specialist child and adolescent mental health services by reducing waiting times after referral to a maximum of 18 weeks. Furthermore the Strategy details policy to reduce under 18s admission to adult wards.

Policy areas that stem from the mental health strategy include working more effectively with families and carers, embedding more peer-to-peer support, increasing support for self-help approaches, extending the anti-stigma agenda through the 'see me' programme, focussing on the rights of those with mental illness, developing the outcomes approach to include personal and social outcomes and ensuring that technology is used effectively to deliver evidence-based services.

Survey background and purpose

1.1 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 (Figure 1.1). These were carried out jointly in Scotland and England between 1982 and 2000, to provide a national picture of young peoples' smoking, drinking, and drug use behaviours within the context of other lifestyle, health and social factors.

1.2 Since 2002, Scotland has developed its own, more tailored, survey known as SALSUS. SALSUS measures progress towards Scottish Government targets for smoking and drug use, and is used to inform the Scottish Government priority of addressing harmful drinking among young people. The survey series also provides local prevalence rates for smoking, drinking and drug use across Alcohol and Drug Partnerships (ADPs), local authorities and NHS Boards. SALSUS data are used in a number of the ADP national core indicators, which allows them to monitor their progress against a common set of outcomes. ADPs and their community planning partners make extensive use of SALSUS data in local needs assessments and in developing their strategic priorities.

Figure 1.1 - History of SALSUS and its predecessors

1.3 Full access to the 2013 results can be found here: http://www.isdscotland.org/Health-Topics/Public-Health/SALSUS/Latest-Report/.

Methodology

1.4 SALSUS is a confidential, self-completion questionnaire that is completed by S2 and S4 pupils, average age 13 and 15 years, in school (previous waves surveyed S1-S4). The survey covers items on smoking, drinking and drug use, as well as a number of contextual questions about lifestyle.

1.5 Since 1990, the datasets from SALSUS and its predecessors have been deposited in the UK data archive. The Scottish Government commissioned Ipsos MORI to examine the feasibility of combining these datasets into a single dataset to facilitate greater use of this resource, and, if it was deemed feasible, to create a unified dataset together with accompanying documentation. Changes in the methodology and questionnaire coverage were examined.

1.6 We concluded that the data was consistent enough that a combined dataset would allow meaningful analysis of trends over time. This combined dataset has now been constructed and this report is one of the first uses of this data source.

1.7 All differences commented on in the report are statistically significant.

Mental health and wellbeing indicators

1.8 SALSUS is foremost a survey about substance use in adolescence and the outputs are therefore focussed on prevalence of smoking, drinking and drug use. However, the survey contains a wealth of information on the behaviour of young people in Scotland over the last 30 years. While these variables are reported on in terms of their relationship with substance use, they have never been reported in their own right.

1.9 This report explores one of the other topics included in SALSUS - mental health and wellbeing. It covers trends in mental health and wellbeing, the profile of those with poorer mental health and wellbeing in 2013, and the factors which best predict positive mental health and wellbeing.

Emotional and behavioural problems - Strengths and Difficulties Questionnaire

1.10 The 'Strengths and Difficulties Questionnaire' (SDQ) was designed by Robert Goodman (1997) (1 - see Reference section) and is widely used by researchers, clinicians and education professionals. This measure has been included in SALSUS since 2006. The questionnaire comprises 25 items that are grouped into 5 scales, with each scale including 5 questions. The scales are:

• emotional symptoms (5 items)
• conduct problems (5 items)
• hyperactivity/inattention (5 items)
• peer relationship problems (5 items)
• pro-social behaviour (5 items).

1.11 Information on how to score the self-completed SDQ was obtained from the website http://www.sdqinfo.com, a site referenced by Goodman et al. For each item in each of the five scales, the value of the responses 'Not true,' 'Somewhat true,' and 'Certainly true' are assigned a value from 0 to 2.

1.12 Overall scores were calculated for each of the five scales by summing the scores for all items within each scale. Total difficulties scores were also calculated as an overall measure of emotional and behavioural problems by summing the scores for emotional problems, conduct problems, hyperactivity and peer problems, but excluding scores for pro-social behaviour.

Mental Wellbeing - Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)

1.13 The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) was developed by researchers at the Universities of Warwick and Edinburgh, with funding provided by NHS Health Scotland, to enable the measurement of mental wellbeing of adults in the UK (2).

1.14 Since 2010, SALSUS has included WEMWBS. Developed as a tool for measuring mental wellbeing at a population level, the scale comprises 14 positively worded statements that relate to an individual's state of mental wellbeing (thoughts and feelings). Pupils were asked to indicate how often they have had such thoughts and feelings over the last two weeks. Each statement has a five item scale ranging from '1 - None of the time' to '5 - All of the time'. The lowest possible score is therefore 14 and the highest is 70.