Scottish Health Survey 2019 - volume 1: main report

Chapter 2: Mental Wellbeing

The mean WEMWBS score for adults in 2019 was 49.8.

Mental wellbeing was higher amongst older than younger adults in 2019.

Differences in the WEMWBS mean scores by area deprivation continued to be evident in 2019.

17% of adults had a GHQ-12 score of four or more* in 2019; prevalence has fluctuated between 14% and 19% since 2003.

As in previous years, women were more likely than men to record a GHQ-12 score of four or more*.

• All adults 17%
• Men 15%
• Woman 19%

Rates of depression**, anxiety**, attempted suicide and self-harm were at their highest levels in 2018/2019 combined.

* Indicative of a possible psychiatric disorder.

** In 2012, there was a change in mode from nurse interview to self-completion data collection.

In 2018/2019 combined, the prevalence of depression, anxiety, attempted suicide and self-harm were highest amongst those living in the most deprived areas.

In 2019, women were signicantly more likely to have reported feeling lonely (often/all of the time) in the last two weeks compared with men.

• 10% All adults
• 9% Men
• 12% Women

Prevalence of loneliness in the last two weeks (often/all of the time) was higher among younger people, particularly among women.

• 12% Men aged 16–24
• 21% Women aged 16–24

Those living in the most deprived areas were more likely to have reported feeling lonely 'often/all of the time' in the last 2 weeks than those living in the least deprived areas.

In 2019, adults who felt lonely 'often/all of the time' in the last two weeks had lower mental wellbeing (WEMWBS mean score) than those who 'rarely/never' felt lonely.

• 37.8 Adults who felt lonely 'often/all of the time'
• 52.9 Adults who 'rarely/never' felt lonely

In 2016– 2019 combined, boys aged 13–15 had higher mental wellbeing (WEMWBS mean score) than girls in the same age group.

Ages 13-15

• Children 51.0
• Boys 52.0
• Girls 49.9

24% of children lived with at least one parent with a GHQ-12score of four or more* in 2019.

* Indicative of a possible psychiatric disorder.

2 Mental Wellbeing

2.1 Introduction

Increasing evidence that mental health is a significant determinant of overall health has established mental health and wellbeing as a global public health priority ^[1],[2],[3]. Mental wellbeing is defined by the World Health Organization as a state of well-being in which every individual realises their own potential, can cope with the stresses of life, can work productively, and is able to make a contribution to their community^[4]. Positive mental wellbeing encourages better quality of life overall, healthier lifestyles, better physical health, improved recovery from illness, better social relationships, and higher educational attainment^[5].

Around one in four^[6] people are estimated to be affected by mental health problems in Scotland in any one year^[7]. It is also evidenced that mental ill health in adolescence increases the risk of subsequent mental ill health later in life^[8]. Globally, both depression and anxiety are more prevalent among women than men^[9], however, rates of suicide remain consistently higher for men than for women around the world^[10].

Mental disorders often co-exist with other diseases, including cancers and cardiovascular disease, diabetes, respiratory illnesses and HIV/AIDS^[11]. People with severe mental disorders have a life expectancy 15-20 years shorter than the general population^[12] with most of those premature deaths being due to physical health conditions^[13].

Poor mental health, including mental disorder, has a considerable impact on individuals, their families and the wider community^[14] and is clearly associated with both poverty and social exclusion^[15]. Loneliness and social isolation are increasingly recognised as significant public health matters^[16]. Although loneliness can affect people of any age and in any circumstances, key groups are at increased risk including those with poor mental and/or physical health, those living in poverty, those with disabilities, those from LGBTI or minority ethnic communities and carers^[17]. The risk of loneliness is greater for those with mental health problems than for those with physical health problems and particularly high for those who experience anxiety, depression or stress^[19],[20]. Additionally, a bi-directional link between social isolation and loneliness and mental health is probable with loneliness itself contributing to the onset and continuation of poor mental health^[21].

As well as specialist mental health services, all public services have a role to play in supporting the mental health and wellbeing of Scotland's population, from Local Government leisure services to primary care and education providers as well as all those living and working alongside each other in Scotland's communities^[22],[23].

This chapter examines adult and child mental health and wellbeing in Scotland in 2019.

2.1.1 Policy background

The Scottish Government is now in the fourth year of delivering the 10-year Mental Health Strategy: 2017-2027^[24]. The strategy is one of many measures to help create a Fairer and a Healthier Scotland^[25]. The guiding ambition for the strategy is to prevent and treat mental health problems with the same commitment, passion and drive that is given to physical health problems. Failing to recognise, prioritise and treat mental health problems harms individuals and communities, and costs the economy. As a result, the strategy focusses on prevention, early intervention and physical wellbeing, as well as equal access to safe and effective treatment and accessible services. The strategy works to ensure protection and promotion of rights, better information use and planning. The importance of improving measurement of outcomes in mental health is emphasised, to include not just data on service activity but also on effect and the experience for people.

The strategy contains 40 initial actions to better join up services and to ensure that those who need help only need to ask once. Underpinning these actions is a commitment to tackle mental health inequalities and embed a human-rights based approach across services with high aspirations for service users. The strategy aims to ensure that people in the most marginalised of situations are prioritised in achieving health.

There is also emphasis on improving support and services for children and young people, including those who come into contact with the criminal justice system. These actions include improving support for mental health and wellbeing in educational settings.

Protecting Scotland's Future^[26],the 2019-2020 Programme for Government, sets out the government's plans to continue to support mental health including the development of a 24/7 crisis support service for children, young people and their families, a community wellbeing service that children and young people can self-refer to, additional school counsellors and investment in a community perinatal mental health service. In December 2018, the Better Mental Health in Scotland^[27] delivery plan was published setting out the approach to the mental health commitments in the Programme for Government including:

• reforming children and young people's mental health services
• improving specialist services for children, young people and adults
• taking a 21st century approach to adult mental health
• respecting, protecting and fulfilling rights; and
• making suicide prevention everybody's business.

The Mental Health (Care and Treatment) (Scotland) Act 2003^[28], which places duties on Local Authorities to provide care and support to people with mental health disorders whilst respecting individuals' rights, has been in force since 2005. An overarching review of Scotland's mental health legislative framework was announced by the Minister for Mental Health in 2019. Chaired by John Scott QC, the work of this independent review is ongoing^[29].

In December 2018 the Scottish Government published A Connected Scotland^[30]its first strategy to address social isolation and loneliness. It sets out key priorities in tackling social isolation and loneliness and a roadmap for their collaborative implementation within communities including:

• empowering communities and building shared ownership to enable approaches that are tailored to local needs
• promoting positive attitudes and tackling stigma
• creating opportunities for people to connect
• supporting an infrastructure (e.g. housing, transport, culture) that fosters connections.

One of the Scottish Government's National Outcomes is the overall strategic objective for health: 'We are healthy and active'^[31]. This is supported by a number of National Indicators including 'mental wellbeing'^[32] which is monitored using data from the Scottish Health Survey (SHeS). The 15 year, on average, premature mortality in people with severe and enduring mental illness^[33] has a major impact on other National Indicators including 'premature mortality' and 'healthy life expectancy'. Scotland also has a set of national, sustainable mental health indicators for adults and children, covering both outcomes and contextual factors that confer increased risks of, or protection from, poor mental health outcomes^[34]. SHeS is the data source for 28 of the 54 indicators for adults^[35] and over 20 of the indicators for children^[36].

2.1.2 Reporting on mental wellbeing in the Scottish Health Survey (SHeS)

This chapter updates trends in mental health and wellbeing for adults including data on the Warwick-Edinburgh Mental Wellbeing Scale(WEMWBS), General Health Questionnaire 12(GHQ-12) and CIS-R anxiety and depression scores, as well as data on attempted suicide and self-harm, loneliness and children living with parents with GHQ-12 scores of four or more. Figures are also reported by age, sex and area deprivation.

The area deprivation data are presented in Scottish Index of Multiple Deprivation (SIMD) quintiles. To ensure that the comparisons presented are not confounded by the different age profiles of the quintiles, the data have been age-standardised. Readers should refer to the Glossary at the end of this Volume for a detailed description of both SIMD and age-standardisation.

Supplementary tables on mental wellbeing are also published on the Scottish Government SHeS website https://www.gov.scot/collections/scottish-health-survey/

2.2 Methods and Definitions

2.2.1 Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)

Wellbeing is measured using the WEMWBS questionnaire. It has 14 items designed to assess: positive affect (optimism, cheerfulness, relaxation) and satisfying interpersonal relationships and positive functioning (energy, clear thinking, self-acceptance, personal development, mastery and autonomy)^[37]. The scale uses positively worded statements with a five-item scale ranging from '1 - none of the time' to '5 - all of the time'. The lowest score possible is therefore 14 and the highest score possible is 70; the tables present mean scores.

The scale was not designed to identify individuals with exceptionally high or low levels of positive mental health, so cut-off points have not been developed^[38].

WEMWBS is used to monitor the National Indicator 'mental wellbeing'^[39] and the mean score of parents of children aged 15 years and under on WEMWBS is included in the mental health indicator set for children^[40].

2.2.2 General Health Questionnaire 12 (GHQ-12)

GHQ-12^[41]is a widely used standard measure of mental distress and mental ill-health consisting of 12 questions on concentration abilities, sleeping patterns, self-esteem, stress, despair, depression, and confidence in the previous few weeks. Responses to each of the GHQ-12 items are scored, with one point allocated each time a particular feeling or type of behaviour is reported to have been experienced 'more than usual' or 'much more than usual' over the previous few weeks.

These scores are combined to create an overall score of between zero and twelve. A score of four or more (referred to as a high GHQ-12 score) has been used here to indicate the presence of a possible psychiatric disorder. A score of zero on the GHQ-12 questionnaire can, in contrast, be considered to be an indicator of psychological wellbeing. GHQ-12 measures deviations from people's usual functioning in the previous few weeks and therefore cannot be used to detect chronic conditions.

2.2.3 Depression and anxiety

Details on symptoms of depression and anxiety are collected via a standardised instrument, the Revised Clinical Interview Schedule (CIS-R). The CIS-R is a well-established tool for measuring the prevalence of mental disorders^[42]. The complete CIS-R comprises 14 sections, each covering a type of mental health symptom and asks about presence of symptoms in the week preceding the interview. Prevalence of two of these mental illnesses - depression and anxiety - were introduced to the Scottish Health Survey in 2008. Given the potentially sensitive nature of these topics, they were included in the nurse interview part of the survey prior to 2012^[43]. Since 2012 the questions have been included in the biological module, with participants completing the questions themselves on the interviewer laptop (CASI). The change in mode of data collection may have impacted response, and comparisons of 2018/2019 figures with pre-2012 figures should be interpreted with caution. There is a possibility that any observed changes in prevalence across this period may simply reflect the change in mode rather than any real change in the population.

2.2.4 Suicide attempts

In addition to being asked about symptoms of depression and anxiety, participants were also asked whether they had ever attempted to take their own life. The question was worded as follows:

Have you ever made an attempt to take your own life, by taking an overdose of tablets or in some other way?

Those who said yes were asked if this was in 'the last week, in the last year or at some other time?' Note that this question is likely to underestimate the prevalence of very recent attempts, as people might be less likely to agree to take part in a survey immediately after a traumatic life event such as this. Furthermore, suicide attempts will only be captured in a survey among people who do not succeed at their attempt.

Since 2012 these questions have been included in the biological module, with participants completing the questions themselves on the interviewer laptop (CASI). Prior to 2012 they were administered in the nurse interview, and any changes over time need to be interpreted with caution due to the change in mode.

2.2.5 Self-harm

Since 2008, participants have been asked whether they have ever self-harmed in any way but not with the intention of killing themselves. Those who said that they had self-harmed were also asked if this was 'in the last week, last year or at some other time'. The percentage of adults who have self-harmed in the last year is one of the national mental health indicators for adults^[44].

Since 2012 these questions have been included in the biological module, with participants completing the questions themselves on the interviewer laptop (CASI). Again, changes over time need to be interpreted in light of this change in the mode of data collection.

2.3 Mental Wellbeing

2.3.1 Adult WEMWBS mean score, 2008 to 2019

The mean WEMWBS score for adults in 2019 was 49.8, equal to that recorded in 2017^[45] and not significantly different from 2018^[46] (49.4). The mean in 2019 was within the range observed over the time series since 2008 (49.4 - 50.0) indicating that the lower mean score in 2018 was not the start of a downward trend in mental wellbeing among adults.

Across the time series, the mean WEMWBS scores for men and women have shown some variation with the average scores for men in the range 49.3 - 50.4 (49.9 in 2019) and for women in the range 49.4 - 49.9 (49.7 in 2019). Figure 2A, Table 2.1

2.3.2 Adult WEMWBS mean score, 2019, by age and sex

Similar to previous survey years^[45] , mental wellbeing was higher among older than younger adults in 2019, with an average WEMWBS score of 52.0 recorded among those aged 65-74 and 50.4 among those aged 75 and over. By comparison, mean WEMWBS scores in the range 49.1 – 49.7 were recorded among those between the ages of 16 and 64.

Similar patterns were evident for both men and women with no significant variations by sex in 2019. Table 2.2

2.3.3 Adult WEMWBS mean score (age-standardised), 2019, by area deprivation and sex

As reported in previous years^[45] , differences in the WEMWBS mean scores by area deprivation continued to be evident in 2019, with a linear decrease from a mean of 51.5 among adults in the least deprived quintile to a significantly lower mean of 46.9 among those in the most deprived quintile.

Similar patterns were recorded for men and women, with a decrease among men from a mean of 51.7 among those in the least deprived quintile to 47.0 among men in the most deprived quintile, with average scores of 51.3 and 46.7 respectively recorded among women. Figure 2B, Table 2.3

2.3.4 Child (13-15) WEMWBS mean scores, 2012-2015 combined and 2016-2019 combined, by sex

To increase the sample size available, the analysis of child (13–15) WEMWBS mean scores, by age and sex, used data from the 2012 to 2015 surveys combined and the 2016 to 2019 surveys combined.

The WEMWBS mean score for all children aged 13 to 15 in 2016-2019 combined was 51.0, equal to that recorded for 2012-2015 combined. As in 2012-2015, there was a significant variation in the scores recorded by sex in 2016-2019, with a mean score of 52.0 recorded among boys and 49.9 among girls, the same figures as were recorded in the previous four-year period by sex. Table 2.4

2.3.5 Child (13-15) WEMWBS mean scores, 2016-2019 combined, by area deprivation and sex

To increase the sample size available, the analysis of WEMWBS mean scores, by area deprivation and sex, used data from the 2016 to 2019 surveys combined.

There was no clear pattern for the average WEMWBS scores by area deprivation, which ranged from 51.8 among those aged 13-15 who lived in the least deprived quintile and 50.8 among those in the most deprived quintile to 50.4 – 51.2 among those living in the other quintiles. Table 2.5

2.3.6 GHQ-12 score, 2008 to 2019, by sex

In 2019, the proportion of all adults with a GHQ-12 score of four or more (indicative of a possible psychiatric disorder) was 17%. This would indicate that the increase recorded in 2018, where the proportion of adults with a score of four or more rose from 17% in 2017 to 19% in 2018^[45] , was not the start of an upward trend. Prevalence in 2019 was similar to that recorded for most other years in the time series; prevalence has ranged between 14% and 19% since 2003.

Likewise, the proportions of adults with a GHQ-12 score of zero (59%) and those with a score of between one and three (24%) in 2019 returned to similar levels as those recorded for most years in the timeseries, with the exception of 2018.

Similar patterns were recorded for both men and women. Table 2.6

2.3.7 GHQ-12 score, 2019, by age and sex

As in previous years, women were more likely than men to record a GHQ-12 score of four or more in 2019 (19% and 15% respectively), while the reverse was evident for the proportions recording a score of zero (56% of women compared with 62% of men). There was no significant difference in the proportions that recorded scores of between one and three by sex (25% among women and 23% among men).

In 2019, the proportion of adults with a GHQ-12 score of four or more generally decreased with age from 23% among those aged 16-24 to 9% of those aged 65-74 and 11% among those aged 75 and over. A slightly different pattern was evident for the proportions with a score of zero, which increased from 49% of those aged 16-24 and to 72% of those aged 65-74 before decreasing to 63% of those aged 75 and over. Similar patterns by age were evident for both men and women. Figures 2C & 2D, Table 2.7

2.3.8 Children living with a parent with GHQ-12 score of 4+, 2019, by age and sex

Around a quarter of children in 2019 lived with a parent(s) with a GHQ-12 score of four or more (indicative of a possible psychiatric disorder) (24%), while around three-quarters were living with a parent(s) with scores of between zero and three (76%). No statistically significant relationships for this measure were evident by sex or age. Table 2.8

2.3.9 CIS-R anxiety and depression scores, attempted suicide and self-harm, 2008/2009 combined to 2018/2019 combined by sex

To increase the sample size available, the analysis of anxiety and depression scores, attempted suicide and self-harm, by sex, used sets of two-years of combined data from 2008/2009 to 2018/2019.

Depression

The trend of increasing prevalence of two or more symptoms of depression continued in 2018/2019 where the proportion was 12%. While not significantly higher than in 2016/2017 (11%), the 2019 figure is the highest rate recorded in the time series, representing an overall increase from 9% in 2012/2013 (when the change in mode was introduced from nurse interview to self-complete) and 8% in 2010/2011.

The proportion of men that reported having two or more symptoms of depression has increased steadily from 7% in 2010/2011 to 12% in 2018/2019. The 2018/2019 figure was significantly higher than the figures observed in both 2010/2011 and 2012/2013 (9%) indicating a real change regardless of the data collection mode (i.e. nurse interview or self-report).

For women the rate has fluctuated over time, however, it remained at the highest level recorded across the time series in 2018/2019 (11%) and was significantly higher than in 2012/2013 (8%). Figure 2E, Table 2.9

Anxiety

In 2018/2019, 14% of adults reported having two or more anxiety symptoms, the highest proportion in the time series compared with 9% as recorded between 2008/2009 and 2012/2013. The 2018/2019 figure was also significantly higher than that recorded in 2016/2017 (14% and 11% respectively).

It was highlighted in the previous SHeS report^[45] that there was some evidence that the proportion of men reporting two or more symptoms of anxiety was increasing (from 7% in 2008/2009 to 9% in 2014/2015 and 2016/2017). The rate in 2018/2019 (13%) was significantly higher than that observed in 2016/2017, a further indication of a possible overall trend of increasing anxiety among men.

As reported previously^[45] , there was an increase over time in the prevalence of two or more symptoms of anxiety among women, which rose from 10% in 2010/2011 to 15% in 2014/2015. However, this rate has fluctuated since, with no significant difference between the 2018/2019 and 2016/2017 figures (15% and 13% respectively).

Over the time series (2008/2009 to 2016/2017), women have been more likely than men to display symptoms of anxiety (between 4 and 6 percentage points higher with the exception of 2010/2011 (2 percentage points higher). However, the significant increase in men that reported two or more symptoms of anxiety in 2018/2019 and the absence of a significant increase for women means that the proportions of men and women reporting two or more symptoms of anxiety in 2018/2019 were not significantly different (13% and 15% respectively). Figure 2F, Table 2.9

Attempted suicide

In 2018/2019, 7% of adults reported that they had attempted suicide at some point in their life, the highest rate in the SHeS time series. The 2017 SHeS report^[44] highlighted evidence of an increasing trend in the attempted suicide rate, however, the difference between the 2016/2017 figure (6%) and that recorded for 2012/2013 (5%) when the mode of collection changed was not statistically significant. However, the proportion of people that reported attempting suicide in 2018/2019 is significantly higher than in 2012/2013 (5% and 7% respectively), suggestive of a real increase in attempted suicide prevalence.

In the 2017 report^[44] , it was suggested that the overall increase in self-reported suicide attempts may have been predominantly driven by an increase observed among men (from 3% in 2012/2013 to 5% in both 2014/2015 and 2016/2017). However, overall increases are evident for both men and women in 2018/2019 (from 3% in 2012/2013 to 6% in 2018/2019 among men and 6% to 9% respectively among women). Prevalence of suicide attempts has consistently been higher for women compared with men over the time series (2-3 percentage points), with the difference just outside of the 95% significance level in 2018/2019. Figure 2G, Table 2.9

Self-harm

The proportion of adults that reported having ever self-harmed was 7% in 2018/2019, within the range 6 - 7% recorded since 2014/2015. The 2018/2019 figure remains significantly higher than in 2010/2011 (2%) and 2012/2013 (5%) when there was a change in mode from nurse administered to self-completion questionnaires.

The patterns over time for men and women were similar, however, women have consistently been more likely than men to report having self-harmed with the largest difference being observed in 2018/2019 (4 percentage points). Figure 2H, Table 2.9

2.3.10 CIS-R anxiety and depression scores, attempted suicide and self-harm, 2018/2019 combined, by age and sex

To increase the sample size available, the analysis of anxiety and depression scores, attempted suicide and self-harm, by age and sex, used data from the 2018 and 2019 surveys combined.

In 2018/2019, there was no significant difference in the proportion reporting two or more symptoms of depression between men and women (12% and 11% respectively). However, prevalence of reporting two or more symptoms of depression varied significantly by age for all adults, with the highest proportion among those aged 45-54 (17%) and lowest among those aged 65-74 (8%).

The overall patterns by age were not significantly different between men and women, however, men aged 45-54 were significantly more likely than women of the same age to report two or more symptoms of depression (23% and 11% respectively).

In 2018/2019, the proportion of men and women that reported two or more symptoms of anxiety were similar (13% and 15% respectively). Prevalence decreased with age, with the highest rate recorded among younger people aged 16-24 and lowest among older people aged 75 and over (21% and 8% respectively). The patterns by age were not significantly different between men and women.

Women were more likely than men to report having ever attempted suicide in the 2018/2019 survey (9% and 6% respectively), with this difference just outside of the 95% significance level. Attempted suicide rates varied significantly by age with those aged 45-54 most likely to report having ever tried to take their own life (12%) and those aged 65 and over least likely to report having done so (3%). A similar pattern by age was observed for both men and women.

Women were more likely to report ever having self-harmed than men in 2018/2019 (9% and 5% respectively) and younger people were more likely than older people to have ever self-harmed (16% of those aged 16-24 compared with 0% of those aged 75 and over).

While there were no significant differences in the overall patterns by age between men and women, a significant difference was recorded between the proportion of women aged 25-34 who had ever self-harmed compared with men of the same age (18% and 5% respectively), while the difference between women aged 16-24 (22%) and men in the same age group (9%) was marginally significant. Table 2.10

2.3.11 CIS-R anxiety and depression scores, attempted suicide and self-harm (age-standardised), 2018/2019 combined, by area deprivation and sex

To increase the sample size available, the analysis of anxiety and depression scores, attempted suicide and self-harm, by area deprivation, used data from the 2018 and 2019 surveys combined.

The prevalence of two or more symptoms of depression varied significantly by area deprivation with adults living in the most deprived quintile more than twice as likely in 2018/2019 to report two or more symptoms of depression than those living in the least deprived quintile (21% and 8% respectively).

The likelihood of reporting two or more symptoms of anxiety was also higher among those living in the most deprived areas (24%) compared with those living in other, less deprived areas (11 – 14%).

A similar pattern was evident for having ever attempted suicide, where adults living in the most deprived areas were around two to four times as likely as those living in less deprived areas to report having ever attempted suicide (15% compared with 4 - 8%).

Rates of self-reported self-harm also varied significantly with area deprivation, with the highest prevalence recorded among those living in the most deprived quintile (13% compared with 5 – 7% among those living in less deprived quintiles).

Similar patterns were reported for both men and women for depression, anxiety, suicide and self-harm when analysed by area deprivation in 2018/2019. Figure 2I, Table 2.11

2.3.12 Adult loneliness, 2019, by age and sex

In 2019, one in ten (10%) adults reported having felt lonely 'often' or 'all of the time' in the two weeks prior to being interviewed. Around two in ten adults (19%) reported having felt lonely 'sometimes' while seven in ten (71%) reported 'rarely' or 'never' feeling lonely in the past two weeks.

Among women, 12% reported feeling lonely 'often' or 'all of the time' in the previous two weeks in 2019, a significantly higher proportion than men (9%). Women were also significantly more likely than men to have reported feeling lonely 'sometimes' (21% compared with 17% respectively) while men were more likely than women to have reported feeling lonely 'rarely' or 'never' in the previous two weeks (75% and 68% respectively).

Young adults were more likely than older adults to have felt lonely 'often' or 'all of the time' in the previous two weeks with around one in six (16%) adults aged 16-24 reporting this compared with around one in twenty (5 - 6%) aged 65 and over. While the overall pattern by age for men and women was not statistically different, women aged 16-24 were significantly more likely than men of the same age to report feeling lonely 'often' or 'all of the time' (21% and 12% respectively). Figure 2J, Table 2.12

2.3.13 Adult loneliness (age-standardised), 2019, by area deprivation and sex

Those living in the most deprived areas were more likely than those in the least deprived areas to experience loneliness (17% of those living in the most deprived quintile reported having felt lonely 'often/all of the time' compared with 6% of those living in the least deprived quintile).

A linear decrease by deprivation was evident in the proportion that reported 'rarely' or 'never' having felt lonely in the two weeks prior to being interviewed, from just under 8 in 10 of those living in the least deprived quintile (78%) to around six in ten of those living in the most deprived quintile (62%). Similar patterns were evident for men and women. Table 2.13

2.3.14 Adult WEMWBS mean score (age-standardised), 2019, by loneliness and sex

In 2019, a significant association between loneliness and mental wellbeing was evident in adults. Those who felt lonely 'often/all of the time' had the lowest mean WEMWBS score (37.8) and the highest mean WEMWBS score was recorded among those that reported 'rarely/never' having felt lonely in the last two weeks (52.9) in 2019. This pattern was evident for both men and women. Table 2.14

Table List

Table 2.1 Adult WEMWBS mean score, 2008 to 2019
Table 2.2 Adult WEMWBS mean score, 2019, by age and sex
Table 2.3 Adult WEMWBS mean score (age-standardised), 2019, by area deprivation and sex
Table 2.4 Child (13-15) WEMWBS mean scores, 2012-2015 combined and 2016-2019 combined, by sex
Table 2.5 Child (13-15) WEMWBS mean scores, 2016-2019 combined, by area deprivation and sex
Table 2.6 GHQ-12 score, 2003 to 2019
Table 2.7 GHQ-12 score, 2019, by age and sex
Table 2.8 Children living with a parent with GHQ-12 score of 4+, 2019, by age and sex
Table 2.9 CIS-R anxiety and depression scores, attempted suicide and self-harm, 2008/2009 combined to 2018/2019 combined, by sex
Table 2.10 CIS-R anxiety and depression scores, attempted suicide and self-harm, 2018/2019 combined, by age and sex
Table 2.11 CIS-R anxiety and depression scores, attempted suicide and self-harm (age-standardised), 2018/2019 combined, by area deprivation and sex
Table 2.12 Adult loneliness, 2019, by age and sex
Table 2.13 Adult loneliness (age-standardised), 2019, by area deprivation and sex
Table 2.14 Adult WEMWBS mean score (age-standardised), 2019, by loneliness and sex

The tables can be found on the main report page under supporting files: https://www.gov.scot/publications/scottish-health-survey-2019-volume-1-main-report/

References and notes

1. World Health Organization (2013). Mental Health Action Plan 2013-2020. [online]. Available from: http://apps.who.int/iris/bitstream/handle/10665/272735/9789241514019-eng.pdf?ua=1

3. World Health Organisation (2019). The WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health. [online]. Available from: https://apps.who.int/iris/bitstream/handle/10665/310981/WHO-MSD-19.1-eng.pdf?ua=1

4. World Health Organization (2014). Mental Health: a state of well-being. [Online] Available from: https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

5. World Health Organization (2009). Mental health, resilience and inequalities. [online]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0012/100821/E92227.pdf

6. Bebbington, P. E. and McManus, S. ORCID: 0000-0003-2711-0819 (2020). Revisiting the one in four: the prevalence of psychiatric disorder in the population of England 2000-2014. The British Journal of Psychiatry: 216(1): 55-57. See: https://openaccess.city.ac.uk/id/eprint/23554/1/revisiting_the_one_in_four_the_prevalence_of_psychiatric_disorder_in_the_population_of_england_20002014.pdf

7. See: https://www.gov.scot/policies/mental-health/

8. Johnson D, Dupuis G, Piche J, Claybourne Z and Coleman I (2018). Adult Mental Health Outcomes of Adolescent Depression: A Systematic Review. Public Medicine: 35(8): 700-716

9. World Health Organization (2020). Depression Fact Sheet. Available from: http://www.who.int/en/news-room/fact-sheets/detail/depression

10. World Health Organization (2017). Depression and Other Common Mental Disorders. Available from: http://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf?sequence=1

11. World Health Organisation (2018). WHO Guidelines: Management of Physical Health Conditions in Adults with Severe Mental Disorders. [online]. Available from: https://apps.who.int/iris/bitstream/handle/10665/275718/9789241550383-eng.pdf?ua=1

12. Mental Health Strategy: 2017-2027 , Edinburgh: Scottish Government, (2017). Available from: http://www.gov.scot/Publications/2017/03/1750

13. World Health Organisation (2018) WHO Guidelines: Management of Physical Health Conditions in Adults with Severe Mental Disorders. [online]. Available from: https://apps.who.int/iris/bitstream/handle/10665/275718/9789241550383-eng.pdf?ua=1

14. World Health Organization (2013). Investing in Mental Health. Available from: https://apps.who.int/iris/bitstream/handle/10665/87232/9789241564618_eng.pdf?sequence=1

15. NHS Health Scotland (2017). Mental Health: Inequality Briefing. [online]. Available from: http://www.healthscotland.scot/media/1626/inequalities-briefing-10_mental-health_english_nov_2017.pdf

16. A Connected Scotland: our strategy for tackling social isolation and loneliness and building stronger social connections. Edinburgh: Scottish Government (2018). Available from:
https://www.gov.scot/publications/connected-scotland-strategy-tackling-social-isolation-loneliness-building-stronger-social-connections/

17. Health Scotland (2018). Social Isolation and Loneliness in Scotland: a review of prevalence and trends. [online]. Available from: http://www.healthscotland.scot/media/1712/social-isolation-and-loneliness-in-scotland-a-review-of-prevalence-and-trends.pdf

18. Melzer H, Bebbington P, Dennis M et al. Feelings of loneliness among adults with mental disorders. Social Psychiatry and Psychiatric Epidemiology 2013; 48: 5–13.

19. Victor CR and Yang K. The prevalence of loneliness among adults: A Case Study of the United Kingdom. The Journal of Psychology 2012; 146(1–2): 85–104.

20. Health Scotland (2018). Social Isolation and Loneliness in Scotland: a review of prevalence and trends. [online]. Available from: http://www.healthscotland.scot/media/1712/social-isolation-and-loneliness-in-scotland-a-review-of-prevalence-and-trends.pdf

21. Better Mental Health in Scotland. Edinburgh: Scottish Government, 2018. Available from:
https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2018/12/programme-government-delivery-plan-mental-health/documents/better-mental-health-scotland/better-mental-health-scotland/govscot%3Adocument

22. A Connected Scotland: our strategy for tackling social isolation and loneliness and building stronger social connections. Edinburgh: Scottish Government (2018). Available from:
https://www.gov.scot/publications/connected-scotland-strategy-tackling-social-isolation-loneliness-building-stronger-social-connections/

23. Mental Health Strategy: 2017-2027. Edinburgh: Scottish Government (2017). Available from: http://www.gov.scot/Publications/2017/03/1750

24. Fairer Scotland Action Plan. Edinburgh: Scottish Government (2016). Available from: http://www.gov.scot/Resource/0050/00506841.pdf

25. Protecting Scotland's Future: The Government's Programme for Scotland 2019-2020. Edinburgh: Scottish Government, (2019). Available from: https://www.gov.scot/publications/protecting-scotlands-future-governments-programme-scotland-2019-20/

26. Better Mental Health in Scotland. Edinburgh: Scottish Government (2018).
Available from: https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2018/12/programme-government-delivery-plan-mental-health/documents/better-mental-health-scotland/better-mental-health-scotland/govscot%3Adocument

27. See: http://www.legislation.gov.uk/asp/2003/13/contents

28. See: https://cms.mentalhealthlawreview.scot/wp-content/uploads/2020/02/Mental-Health-Legislation-Review-Call-for-Evidence-Final.pdf

29. A Connected Scotland: our strategy for tackling social isolation and loneliness and building stronger social connections. Edinburgh: Scottish Government (2018). Available from:
https://www.gov.scot/publications/connected-scotland-strategy-tackling-social-isolation-loneliness-building-stronger-social-connections/

30. The National Performance Framework is described here: http://nationalperformance.gov.scot/

31. See: http://nationalperformance.gov.scot/

32. Langan J, Mercer S, W, Smith, D, J. (2013) Multimorbidity and Mental Health: Can Psychiatry Rise to the Challenge? The British Journal of Psychiatry 202: 391-393.

33. See: www.healthscotland.com/scotlands-health/population/mental-health-indicators.aspx

34. Scotland's Mental Health: Adults 2012. Edinburgh: NHS Health Scotland, (2012). Available from: www.healthscotland.com/documents/6123.aspx

35. NHS Health Scotland / ScotPHO (2013). Scotland's Mental Health: children and young people 2013. [online]. Available from: https://www.scotpho.org.uk/publications/reports-and-papers/scotland-s-mental-health-children-and-young-people-2013/

36. Further information about WEMWBS is available from: www.healthscotland.com/scotlands-health/population/Measuring-positive-mental-health.aspx

37. Stewart-Brown, S and Janmohamed, K (2008). Warwick-Edinburgh Mental Well-being Scale (WEMWBS). User Guide Version 1. Warwick and Edinburgh: University of Warwick and NHS Health Scotland. Available from: http://www.healthscotland.com/documents/2702.aspx

38. See: http://nationalperformance.gov.scot/

39. NHS Health Scotland (2012) Establishing a core set of national, sustainable mental health indicators for children and young people in Scotland: Final Report. [online]. Available from: http://www.healthscotland.com/uploads/documents/18753-C&YP%20Mental%20Health%20Indicators%20FINAL%20Report.pdf

40. Goldberg, D and Williams, PA (1988). A User's Guide to the General Health Questionnaire. Windsor: NFER-Nelson.

41. Lewis, G. & Pelosi, A. J. (1990). Manual of the Revised Clinical Interview Schedule CIS–R. London: Institute of Psychiatry; Lewis G, Pelosi AJ, Araya R, Dunn G. (1992) Measuring psychiatric disorder in the community; a standardised assessment for use by lay interviewers. Psychological Medicine; 22, 465-486.

42. The nurse interview is conducted with one adult at a time, whereas the main interview can be conducted concurrently with up to four household members present. It was therefore easier to ensure that these questions could be answered in confidence. Nurses were also thought to be better placed to handle very sensitive topics such as these than interviewers conducting a general health survey who would have required additional specialist briefing. A leaflet with various help lines was handed to all participants in the nurse visit. From 2012, these questions have been included in the biological module of the survey, conducted by specially trained interviewers, and will be completed by participants using a self-completion computer aided questionnaire.

43. See: www.healthscotland.com/scotlands-health/population/mental-health-indicators.aspx

44. Dougall, I. (2017). Chapter 2: Mental Health and Wellbeing. McLean, J., Christie, S., Hinchcliffe, S. and Gray, L. (eds). The Scottish Health Survey – 2017 edition: volume 1: main report. Edinburgh: Scottish Government. Available from: https://www.gov.scot/publications/scottish-health-survey-2017-volume-1-main-report/

45. Dougall, I. (2018). Chapter 1: Mental Wellbeing. McLean, J. Dean, L. (eds). The Scottish Health Survey – 2018 edition: volume 1: main report. Edinburgh: Scottish Government. Available from:
https://www.gov.scot/publications/scottish-health-survey-2018-volume-1-main-report/