Subjective health and mental well‐being of adolescents and the health promoting school

Mental health and loneliness in Scottish schools: A multilevel analysis of data from the health behaviour in school-aged children study

BACKGROUND

Adolescent loneliness and poor mental health represent dual public health concerns. Yet, associations between loneliness and mental health, and critically, how these associations vary in school settings are less understood.

AIMS

Framed by social-ecological theory, we aimed to identify key predictors of adolescent mental health and examine school-level variation in the relationship between loneliness and mental health.

SAMPLE

Cross-sectional data on adolescents from the 2018 wave of the Health Behaviour in School-aged Children study (HBSC) in Scotland were used (N = 5286).

METHODS

Mental health was measured as a composite variable containing items assessing nervousness, irritability, sleep difficulties and feeling low. Loneliness was measured via a single item assessing how often adolescents felt 'left out'. Multilevel models were used to identify social-ecological predictors of mental health, associations with loneliness and between-school variation.

RESULTS

Loneliness, as well as demographic, social and school factors, was found to be associated with mental health. Mental health varied across schools, with the between-school difference greater among adolescents with high levels of loneliness. Additionally, the negative effect of loneliness on mental health was stronger in schools with lower average mental health scores.

CONCLUSIONS

The findings suggest that schools can play an important role in shaping adolescent mental health. Our study uniquely identifies that school-based interventions targeting mental health may be especially necessary among lonely adolescents, and programmes aimed at tackling loneliness may be more beneficial in schools with poorer mental health.

A bio-ecological framing of evidence on the determinants of adolescent mental health - A scoping review of the international Health Behaviour in School-Aged Children (HBSC) study 1983-2020

This paper extracts, organises and summarises findings on adolescent mental health from a major international population study of young people using a scoping review methodology and applying a bio-ecological framework. Population data has been collected from more than 1.5 million adolescents over 37 years by the Health Behaviour in School-Aged Children: WHO Cross-National (HBSC) Study. The paper reviews the contribution that this long standing study has made to our understanding of the individual, developmental, social, economic, cultural determinants of adolescent mental health by organising the findings of 104 empirical papers that met inclusion criteria, into individual, microsystem, mesosystem and macrosystem levels of the framework. Of these selected papers, 68 were based on national data and the other 36 were based on international data, from varying numbers of countries. Each paper was allocated to a system level in the bio-ecological framework according to the level of its primary focus. The majority (51 papers) investigate individual level determinants. A further 28 concentrate primarily on the microsystem level, 6 on the mesosystem level, and 29 on the macrosystem level. The paper identifies where there is evidence on the determinants of mental health, summarises what we have learned, and highlights research gaps. Implications for the future development of this population health study are discussed in terms of how it may continue to illuminate our understanding of adolescent mental health in a changing world and where new directions are required.

Implementing a Mentally Healthy Schools Framework based on the population wide Act-Belong-Commit mental health promotion campaign

Purpose

Mentally Healthy WA developed and implemented the Mentally Healthy Schools Framework in 2010 in response to demand from schools wanting to promote the community-based Act-Belong-Commit mental health promotion message within a school setting. Schools are an important setting for mental health promotion, therefore, the Framework encourages schools to adopt a whole-of-school approach to mental health promotion based on the World Health Organisation’s Health Promoting Schools framework. The paper aims to discuss these issues.

Design/methodology/approach

A process evaluation was conducted consisting of six-monthly activity reports from 13 participating Western Australian schools. Semi-structured interviews were also conducted with key school contacts in November 2011 with nine schools who had signed partner agreements prior to July 2011.

Findings

The schools valued promoting the mentally healthy message and the majority felt the programme was implemented successfully. More intensive implementation was facilitated by a proactive and enthusiastic school “champion” who had influence over other staff, and who did not have too many competing priorities. Factors inhibiting implementation included a lack of effective time management, lack of whole school commitment, and evaluation demands.

Originality/value

Act-Belong-Commit is a positive, proactive message making it easier for teachers to talk about mental health with their students. For schools reporting implementation success, the Mentally Healthy Schools Framework raised the profile of mental health in the school setting and fostered a sense of belonging among students.

Weight concerns among adolescent boys

OBJECTIVE

To investigate weight concerns among adolescent boys and relationships with health indicators and family factors.

DESIGN

Analysis of the 2010 Health Behaviour in School-aged Children survey of 10-17-year-olds.

SETTING

Schools in the Republic of Ireland.

RESULTS

Among 6187 boys, 25.1% reported a desire to lose weight (weight 'loss' concern) and 7.7% reported a desire to gain weight (weight 'gain' concern). Both types of weight concerns were associated with poor self-rated health, life satisfaction and happiness, and with more frequent emotional and physical symptoms. Family factors were associated with boys' weight concerns. In adjusted analyses, the risk of weight 'loss' concerns decreased with daily family breakfasts (OR=0.80; 95% CI 0.66, 0.97). The risk of weight 'gain' concerns decreased with frequent family evening meals (OR=0.77; 95% CI 0.60, 0.99). Ease of communication with mother was associated with a decreased risk of weight 'loss' and weight 'gain' concerns among boys (OR=0.74; 95% CI 0.60, 0.90 and OR=0.61; 95% CI 0.44, 0.82, respectively). An open father-son relationship and having a father present in the home decreased the risk of weight 'loss' concerns (OR=0.69; 95% CI 0.57, 0.82 and OR=0.81; 95% CI 0.67, 0.98, respectively).

CONCLUSIONS

Body weight concerns were reported by a sizeable minority of boys and were associated with negative health outcomes. The findings support the need to promote frequent family meals and facilitate open communication in families.

Promotion of social and emotional competence

Purpose

– Within the framework of Health Promoting Schools Up is an intervention using a whole school approach aimed at promoting mental health by strengthening social and emotional competence among schoolchildren. Social and emotional competence is an integral part of many school-based mental health interventions but only a minority of interventions measure changes in competences. The purpose of this paper is to present the intervention Up and document changes in social and emotional competence among schoolchildren before and after the intervention.

Design/methodology/approach

–Up consists of four components: education and activities for schoolchildren; development of staff skills; involvement of parents; and initiatives in everyday life at school. Up was implemented in two Danish schools in 2010-2011. Social and emotional competence was measured among 11-15-year old schoolchildren before (response rate 96.2 per cent, n=589) and after (response rate 83.9 per cent, n=532) the intervention.

Findings

– Changes in level of social competence were assessed by the prevalence of a high level of social and emotional competence before (33.3 per cent) and after (40.8 per cent) the intervention (p-value=0.01).

Research limitations/implications

–Up provides valuable experiences for adapting evidence-based mental health promotion to the Danish school system which is characterized by democracy, autonomy and inclusion. Future research should study the implementation and effect of Up in larger scale studies.

Practical implications

– The comprehensive description of Up serves as important information for policymakers and practitioners working with mental health promotion.

Originality/value

– The whole school approach intervention Up has the potential to promote social and emotional competence and reduce socioeconomic differences in social and emotional competence among schoolchildren.

Changes in the association between health complaint frequency and medicine use among adolescents in Scotland between 1998 and 2010

OBJECTIVE

Medicines have the potential to cause harm, particularly when adolescents do not follow recommendations for use. In addition, medicine use in adolescence has been shown to track into adulthood. There is therefore a strong rationale to monitor changes in adolescent medicine use over time and understand the mechanisms behind these changes

METHODS

Data from the 1998, 2006 and 2010 Scotland Health Behaviour in School-aged Children Survey were modelled using multilevel logistic regression, modelling medicine use for: headache, stomachache, sleeping difficulties and nervousness, as well as a combined medicine use measure. Models adjusted for year and frequency of health complaints to measure trends in medicine use, and an interaction term to measure the relationship between medicine use and health complaint frequency.

RESULTS

Medicine use reduced between 1998 and 2010. Hownever having the majority of the reduction was observed between 1998 and 2006 for all five outcomes. Adjustment for health complaint frequency only explained some of this reduction. When an interaction term was added between year and health complaint frequency this was significant for boys' medicine use, suggesting that health complaint frequency became a better predictor of medicine use with time. Medicine use for stomachache among girls increased over time, and this increase became more pronounced after adjustment for stomachache frequency.

CONCLUSION

Changes in health complaint frequency were only partly associated with reductions in medicine use between 1998 and 2010. Further monitoring of medicine use is recommended, particularly the use of medicine for sleep difficulties, and for stomachache among girls.

Increased cancer awareness among British adolescents after a school-based educational intervention: a controlled before-and-after study with 6-month follow-up

BACKGROUND

There is a lack of evidence around the effectiveness of school-based interventions designed to raise adolescents' cancer awareness. To address this deficit this study assessed the impact of an intervention delivered in the United Kingdom by Teenage Cancer Trust on: recall (open question) and recognition (closed question) of cancer warning signs; knowledge of common childhood, teenage, male and female cancers; awareness of the relationship between cancer and age; anticipated medical help-seeking delay; perceived barriers to seeking medical advice about cancer; and examined variation of intervention effect by gender and whether adolescents reported that they knew someone with cancer.

METHODS

The Cancer Awareness Measure (CAM) was completed by 422 adolescents (male: 221, 52.4%) aged 11-17 years old (mean age=13.8, standard deviation=1.26) two weeks before and two weeks after the intervention in three schools, and on two occasions four weeks apart in a fourth (control) school. Intervention schools were followed-up 6-months post-intervention.

RESULTS

Recognition of nine common cancer warning signs significantly increased two weeks after the intervention (4.6 to 6.8, p<0.001) and was maintained at 6-month follow-up (6.2, p<0.001). Endorsement of emotional barriers to help-seeking 'not confident to talk about symptoms' (53% to 45%, p=0.021) and 'worried about what the doctor might find' (70% to 63%, p=0.021) significantly decreased two weeks after the intervention but changes were not maintained at 6-months. The intervention had a greater impact on females and those who knew someone with cancer.

CONCLUSIONS

The intervention is an effective way to raise adolescents' cancer awareness, especially of cancer symptoms. Further development and evaluation is required to maximise intervention impact, particularly on barriers to help-seeking behaviour.