Trends in mental well-being of year old boys and girls in Scotland,

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1 Trends in mental well-being of year old boys and girls in Scotland, Kate Levin, Candace Currie Child and Adolescent Health Research Unit University of Edinburgh

2 Mental Health in Scotland 30% of GP consultations are for mental health problems * 40% more per head is spent on antidepressant prescriptions than in England * The suicide rate in Scotland in 2002 was over twice that of England * The suicide rate of year old males in Scotland increased by 99% during The suicide rate of year old females in Scotland increased by 177% during * Source: Health in Scotland 2002, Scottish Executive

3 Mental Health among Young people Mental health problems are predictors of externalizing behaviours Mental health problems during adolescence may predict mental well-being and behavioural problems in adulthood Negative v Positive mental health

4 Mental Health among Young people in Scotland National Programme for Improving Mental Health and Well-Being (Scottish Executive, 2003) The focus is on: Promoting mental well-being Preventing mental health problems Supporting those experiencing mental health problems Eliminating stigma Addressing inequalities in mental health

5 Aims To describe changes in mental well-being among adolescents living in Scotland between 1994 and 2006 (are we successfully promoting well-being?) To examine socio-economic inequalities in mental well-being To examine how socioeconomic inequalities in mental well-being have changed between 1998 and 2006 (are we successfully addressing inequalities in mental health?)

6 Data HBSC survey data from 1994, 1998, 2002 and 2006 surveys Mental well-being outcome measures: Happiness: Confidence: Helplessness: Feeling left out: Multiple health complaints (MHC): Explanatory variables: sex, age, family affluence, year

7 Methods For each measure of mental well-being: Graphs of trends Multilevel modelling for boys and girls separately: adjusting for age and year adjusting for age, year and FAS adjusting for age, FAS, year and an interaction term between FAS and year Levels: region/school type, school, child

8 Happiness

9 Happiness Proportion of boys and girls that are very happy Boys Girls

10 11-15 year old Boys Outcome measure: very happy/ quite happy or not very happy or not happy at all Variable OR 95% CI Model 1: adjusting for age and year Age 0.83 (0.81, 0.85) Year (ref: 1994) (1.14, 1.48) (1.39, 1.82) (1.49, 1.94) Model 2: adjusting for age, year and FAS Age 0.82 (0.80, 0.85) Year 1.03 (1.02, 1.05) FAS (ref: low FAS) Middle FAS 1.24 (1.10, 1.39) High FAS 1.20 (1.08, 1.34)

11 11-15 year old Boys Outcome measure: very happy/ quite happy or not very happy or not happy at all Variable OR 95% CI Model 3: adjusting for age and year, FAS and FAS*year interaction Age 0.82 (0.80, 0.85) Year 1.02 (0.99, 1.04) FAS (ref: low FAS) Middle FAS 1.15 (0.83, 1.60) High FAS 0.88 (0.65, 1.21) Year*FAS interaction (ref: Year*Low FAS) Year*Middle FAS 1.01 (0.97, 1.04) Year*High FAS 1.03 (1.00, 1.07)

12 11-15 year old Girls Outcome measure: very happy/ quite happy or not very happy or not happy at all Variable OR 95% CI Model 1: adjusting for age and year Age 0.78 (0.76, 0.80) Year (ref: 1994) (0.97, 1.32) (1.28, 1.77) (1.50, 2.03) Model 2: adjusting for age, year and FAS Age 0.78 (0.76, 0.80) Year 1.05 (1.04, 1.07) FAS (ref: low FAS) Middle FAS 1.20 (1.06, 1.35) High FAS 1.30 (1.16, 1.46)

13 11-15 year old Girls Outcome measure: very happy/ quite happy or not very happy or not happy at all Variable OR 95% CI Model 3: adjusting for age and year, FAS and FAS*year interaction Age 0.78 (0.76, 0.80) Year 1.03 (0.99, 1.05) FAS (ref: low FAS) Middle FAS 0.97 (0.69, 1.35) High FAS 0.85 (0.61, 1.19) Year*FAS interaction (ref: Year*Low FAS) Year*Middle FAS 1.02 (0.99, 1.06) Year*High FAS 1.05 (1.01, 1.08)

14 Confidence

15 Confidence Proportion of boys and girls who are always confident Boys Girls

16 11-15 year old Boys Outcome measure: always confident/ often, sometimes, hardly ever or never confident Variable OR 95% CI Model 1: adjusting for age and year Age 0.86 (0.83, 0.89) Year (ref: 1994) (0.83, 1.16) (1.04, 1.47) (0.95, 1.32) Model 2: adjusting for age, year and FAS Age 0.84 (0.82, 0.87) Year 1.02 (1.00, 1.03) FAS (ref: low FAS) Middle FAS 1.10 (0.96, 1.26) High FAS 1.11 (0.98, 1.27)

17 11-15 year old Girls Outcome measure: always confident/ often, sometimes, hardly ever or never confident Variable OR 95% CI Model 1: adjusting for age and year Age 0.79 (0.76, 0.82) Year (ref: 1994) (0.98, 1.48) (1.19, 1.82) (1.15, 1.72) Model 2: adjusting for age, year and FAS Age 0.79 (0.75, 0.82) Year 1.02 (0.99, 1.04) FAS (ref: low FAS) Middle FAS 1.13 (0.96, 1.33) High FAS 1.21 (1.04, 1.42)

18 Helplessness

19 Helplessness Proportion of boys and girls who never feel helpless Boys Girls

20 11-15 year old Boys Outcome measure: never feel helpless/ hardly ever, sometimes, often or always feel helpless Variable OR 95% CI Model 1: adjusting for age and year Age 0.96 (0.93, 0.98) Year (ref: 1994) (0.98, 1.29) (1.38, 1.83) (1.49, 1.95) Model 2: adjusting for age, year and FAS Age 0.95 (0.92, 0.98) Year 1.05 (1.04, 1.07) FAS (ref: low FAS) Middle FAS 1.11 (0.99, 1.25) High FAS 1.09 (0.97, 1.22)

21 11-15 year old Girls Outcome measure: never feel helpless/ hardly ever, sometimes, often or always feel helpless Variable OR 95% CI Model 1: adjusting for age and year Age 0.87 (0.84, 0.90) Year (ref: 1994) (1.10, 1.56) (1.32, 1.89) (1.62, 2.27) Model 2: adjusting for age, year and FAS Age 0.85 (0.83, 0.88) Year 1.05 (1.03, 1.07) FAS (ref: low FAS) Middle FAS 1.07 (0.94, 1.21) High FAS 1.14 (1.00, 1.29)

22 Feeling left out

23 Feeling left out Proportion of boys and girls who never feel left out Boys Girls

24 11-15 year old Boys Outcome measure: never feel left out/ hardly ever, sometimes, often or always feel left out Variable OR 95% CI Model 1: adjusting for age and year Age 0.90 (0.87, 0.94) Year (ref: 1998) (0.84, 1.14) (1.05, 1.39) Model 2: adjusting for age, year and FAS Age 0.91 (0.87, 0.94) Year 1.02 (1.01, 1.04) FAS (ref: low FAS) Middle FAS 0.98 (0.86, 1.13) High FAS 1.01 (0.88, 1.15)

25 11-15 year old Girls Outcome measure: never feel left out/ hardly ever, sometimes, often or always feel left out Variable OR 95% CI Model 1: adjusting for age and year Age 0.90 (0.86, 0.94) Year (ref: 1998) (0.82, 1.18) (1.09, 1.50) Model 2: adjusting for age, year and FAS Age 0.90 (0.87, 0.94) Year 1.03 (1.01, 1.05) FAS (ref: low FAS) Middle FAS 0.95 (0.81, 1.11) High FAS 0.96 (0.82, 1.12)

26 Multiple health complaints

27 Multiple health complaints Proportion of boys and girls that do not report multiple health complaints Boys Girls

28 11-15 year old Boys Outcome measure: < 2 weekly health complaints/ 2+ weekly health complaints Variable OR 95% CI Model 1: adjusting for age and year Age 1.06 (1.03, 1.09) Year (ref: 1994) (0.92, 1.26) (0.95, 1.32) (1.14, 1.57) Model 2: adjusting for age, year and FAS Age 1.04 (1.01, 1.08) Year 1.03 (1.01, 1.04) FAS (ref: low FAS) Middle FAS 1.20 (1.05, 1.37) High FAS 1.32 (1.16, 1.50)

29 11-15 year old Boys Outcome measure: < 2 weekly health complaints/ 2+ weekly health complaints Variable OR 95% CI Model 3: adjusting for age and year, FAS and FAS*year interaction Age 1.04 (1.01, 1.08) Year 1.01 (0.98, 1.03) FAS (ref: low FAS) Middle FAS 1.04 (0.72, 1.51) High FAS 0.92 (0.64, 1.31) Year*FAS interaction (ref: Year*Low FAS) Year*Middle FAS 1.02 (0.98, 1.06) Year*High FAS 1.04 (1.00, 1.08)

30 11-15 year old Girls Outcome measure: < 2 weekly health complaints/ 2+ weekly health complaints Variable OR 95% CI Model 1: adjusting for age and year Age 0.93 (0.90, 0.95) Year (ref: 1994) (0.89, 1.22) (0.91, 1.26) (1.06, 1.44) Model 2: adjusting for age, year and FAS Age 0.91 (0.89, 0.94) Year 1.02 (1.01, 1.04) FAS (ref: low FAS) Middle FAS 1.26 (1.12, 1.41) High FAS 1.42 (1.26, 1.60)

31 11-15 year old Girls Outcome measure: < 2 weekly health complaints/ 2+ weekly health complaints Variable OR 95% CI Model 3: adjusting for age and year, FAS and FAS*year interaction Age 0.91 (0.89, 0.94) Year 1.01 (0.98, 1.03) FAS (ref: low FAS) Middle FAS 1.22 (0.87, 1.70) High FAS 1.00 (0.72, 1.38) Year*FAS interaction (ref: Year*Low FAS) Year*Middle FAS 1.00 (0.97, 1.04) Year*High FAS 1.04 (1.01, 1.08)

32 Summary I The proportions of boys who are very happy, never feel left out, never feel helpless and report fewer than 2 weekly health complaints have significantly increased over time The proportions of girls who are very happy, always confident, never feel left out, never feel helpless and report fewer than 2 weekly health complaints have significantly increased over time

33 Summary II Higher proportions of boys than girls feel very happy, are always confident, never feel left out, never feel helpless and report fewer than 2 weekly health complaints The probability of being very happy, always confident, feeling helpless or left out decreases with age for boys and girls (especially for girls) The probability of not having weekly health complaints increases with age for boys and decreases with age for girls

34 Summary III Among boys there are socioeconomic inequalities in happiness and multiple health complaints Over time, these inequalities increase Among girls there are socioeconomic inequalities in happiness, confidence, helplessness and multiple health complaints Over time, inequalities in girls happiness and multiple health complaints increase, while inequalities in confidence and helplessness persist but do not increase or decrease

35 Conclusion While we appear to be promoting mental well-being successfully with increases in all indicators over time, inequalities for some indicators persist and in some cases have widened between 1998 and 2006.