Insights into adolescent mental health in Scotland

Insights into adolescent mental health in Scotland: A national report, carried out every four years in collaboration with the World Health Organisation (WHO), presenting data on adolescent health and wellbeing has provided a special focus insight into young people’s mental health in Scotland. The latest report also enables comparison of adolescent health and wellbeing before and after the COVID-19 pandemic.

The 2022 Health Behaviour in School-aged Children (HBSC) study in Scotland provides data on the health and wellbeing of the nation’s young people and was led by researchers at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow and the School of Medicine – University of St Andrews (st-andrews.ac.uk). The report was commissioned by Public Health Scotland (PHS).

Key findings include the majority (80%) of young people reported high life satisfaction in 2022, and around a fifth (23%) of adolescents rated their health as excellent, with the proportion of boys reporting excellent health increasing since 2018 from 22% to 27%. However, nearly half (49%) of young people experienced multiple health complaints every week (the most common being feeling nervous, sleep difficulties and feeling irritable), and prevalence was higher among girls than boys at ages 13 and 15.

Pandemic impacts were another key finding, with the most positively affected aspects of life reported during the pandemic being family relations (54%) and friendships (50%). While 43% also reported a positive impact on their physical activity, 29% said that their physical activity had been negatively affected. The main negative impacts overall were on mental health (38%) and school performance (34%).

The report also revealed the lowest levels of adolescent confidence seen in 28 years, with only 42% of adolescents in Scotland reporting often or always feeling confident in themselves. Notably, around a fifth (19%) of young people reported feeling lonely all or most of the time in the past year, and feelings of loneliness were highest among 15-year-old girls (31%). The report also found that around a third of young people reported anxiety, with higher levels among girls than boys; and over a third (35%) were classified as having either low mood or risk of depression.

Beyond mental health and wellbeing, the HBSC study covers areas such as sleep habits, screen time, physical activity, sexual health and eating behaviours, as well as school and home life. The report presents data collected from a representative sample of 4,388 eleven, thirteen and fifteen-year-olds in Scotland in 2022. The survey was conducted in schools, with all pupils in the selected classes asked to fill in the confidential questionnaire anonymously.

This is the 9th consecutive World Health Organisation (WHO) cross-national HBSC survey in which Scotland has participated, providing data on the health of the nation’s young people since 1990.

Lead author of the study Dr Jo Inchley, from the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, said: “These latest findings from HBSC provide a comprehensive picture of young people’s health across Scotland. We’ve seen significant improvements in recent years in areas such as alcohol use and lifetime cigarette smoking.

“But at the same time, new challenges such as vaping and social media are increasingly impacting on how young people live their lives, and there are also significant mental health challenges which are likely to have been exacerbated by the COVID-19 pandemic. This report helps us to better understand the challenges young people face, recognise the broader impact of the pandemic on their lives, and look at areas where more support and investment is needed.”

Dr Richmond Davies, Head of Public Mental Health and Child Public Health at Public Health Scotland, said: “The insight the HBSC study provides into trends in young people’s health, wellbeing and socioeconomic circumstances is invaluable and highlights the need to prevent poor mental health before it emerges.

“We have good evidence of what the drivers of mental health are, so we must not ignore opportunities to increase young people’s exposure to protective factors and reduce their exposure to, and the impact of, the factors that harm their mental health.

“Key drivers of poor mental health in young people include: poverty and economic deprivation; the availability and quality of opportunities post-school; and supportive relationships with peers, family and trusted adults in the community.”

Dorothy Currie, from the School of Medicine at St Andrews University, said: “This most recent HBSC report highlights continuing challenges around gender and socio-economic inequalities in health among young people in Scotland, across areas such as mental health, physical activity, eating behaviour and including the impact of the COVID-19 pandemic. While many Scottish adolescents reported positive impacts of the pandemic across several aspects of their lives, this was less true for those from less affluent families and initiatives aimed at reducing health inequalities among this age group must remain a priority.”

Other findings of note from the report include:

Mental health and wellbeing

• Nearly a quarter (23%) of young people reported feeling left out often or always compared with 11% in 2018, and this increase was seen in both boys and girls.
• In particular, the proportion of girls feeling left out often or always has more than doubled since 2018, from 13% to 30%.
• Just over a quarter (27%) of young people reported feeling very happy with their life, with boys more likely to report this than girls (34% versus 21% — the lowest prevalence of feeling very happy since 1994).
• Nearly all the mental health and wellbeing indicators were significantly associated with family affluence, with poorer outcomes for those from families with lower affluence, except for anxiety and feeling left out, which did not vary by family affluence.

School experience

• Between 1994 and 2018 there was little change in the proportion of young people who liked school a lot but there were decreases in 2022 compared with 2018 (particularly for girls, down from 27% to 15%).
• The proportion of adolescents who felt some or a lot of pressure from schoolwork has been increasing since 2006 and has continued to increase in 2022 for girls, widening the gap between girls and boys.

General health and sleep

• The prevalence of multiple health complaints is at its highest since 1994 for both boys and girls, with a particular increase for girls from 41% in 2018 to 61% in 2022.
• The average sleep duration on weekdays was 8.0 hours for 13-year-olds and 7.7 hours for 15-year-olds – the recommended sleep for teenagers is 8 to 10 hours each night.
• The proportion of young people reporting sleep difficulties more than once a week has continued to increase from 30% in 2018 to 37% in 2022.

Electronic media use

• Almost one in seven (14%) reported problematic social media use, with girls more likely to report this than boys (20% versus 8%, respectively – an increase since 2018).
• The vast majority (85%) kept their smartphones in their bedroom at night.
• Of those who played video games, 12% reported problematic gaming. Boys were more likely than girls to report problematic gaming (18% versus 7%).

Bullying and fighting

• 7% of young people reported being cyberbullied at least two to three times a month in the past couple of months, and this was similar to previous survey years.
• Just over one-fifth (22%) of young people reported experiencing multiple forms of bullying in the last two to three months (this has increased from 15% in 2018).

Substance abuse

• Lifetime cigarette smoking is at its lowest level in 32 years. Vaping has now overtaken cigarette smoking, with almost one in five (18%) adolescents reporting having used an e-cigarette at least once in their lifetime.
• There have been large increases in e-cigarette use since 2018 for girls: in 2022, 40% of 15-year-olds girls had used an e-cigarette in their lifetime, compared with 20% in 2018.
• There have been increases in current e-cigarette use since 2018 for 13-year-old girls (2% to 13%) and larger increases for 15-year-olds (girls 6% to 30% and boys 8% to 20%).
• Since 1998, levels of drunkenness have declined steadily and are now at their lowest in 32 years.
• One in ten (10%) 15-year-olds reported using cannabis in the last 30 days and levels were similar in boys and girls.

Physical activity

• Less than a quarter (23%) of adolescents achieved 60 minutes of moderate to vigorous physical activity (MVPA) a day.
• MVPA has increased since 2018, particularly for boys (from 19% to 28%).

Relationships

• Half of young people (50%) reported high levels of support from their friends.
• Since 2014, perceptions of peer support have remained relatively stable among boys but, for girls, there has been a recent decrease in high peer support from 65% in 2014 to 54% in 2022.

Eating behaviours

• Levels of fruit consumption are the highest in 20 years. Four in ten (40%) young people ate vegetables every day and this did not vary significantly by age or gender.
• In 2022, daily vegetable consumption among boys increased to its highest level since 2002.
• Daily consumption of sweets and chocolate, chips and sugary drinks have increased slightly since 2018. Nearly one in ten (9%) young people drank an energy drink every day, up from 5% in 2018.

Further information

The HBSC cross-national study, of which the Scottish study is part, began in 1983 in three countries, and has now grown to include 51 countries and regions across Europe and North America. The first Scottish HBSC survey was conducted in 1990, and national surveys have been conducted every four years since then, in line with the cross-national survey cycle.

Findings from the 2022 HBSC survey are presented and these are compared to equivalent data, where available, from eight previous survey rounds (1990, 1994, 1998, 2002, 2006, 2010, 2014 and 2018). A nationally representative sample of 4,388 pupils participated in the 2022 Scottish HBSC survey.

The Scottish study is based at the MRC/CSO Social and Public Health Sciences Unit (SPSHU), University of Glasgow and undertaken in collaboration with the School of Medicine, University of St Andrews. The SPHSU also hosts the HBSC International Coordinating Centre (ICC). The study is funded by Public Health Scotland.

HBSC Scotland data are also used to support school-based health improvement activities through the Scottish Schools Health and Wellbeing Improvement Research Network (SHINE), also based at the SPHSU, University of Glasgow. SHINE aims to support improvements in health and wellbeing amongst school-aged children by building a collaboration between schools, researchers and policy-makers, and HBSC data are used by schools in the network to help identify their key health and wellbeing needs.

Further information

The HBSC cross-national study, of which the Scottish study is part, began in 1983 in three countries, and has now grown to include 51 countries and regions across Europe and North America. The first Scottish HBSC survey was conducted in 1990, and national surveys have been conducted every four years since then, in line with the cross-national survey cycle.

Findings from the 2022 HBSC survey are presented and these are compared to equivalent data, where available, from eight previous survey rounds (1990, 1994, 1998, 2002, 2006, 2010, 2014 and 2018). A nationally representative sample of 4,388 pupils participated in the 2022 Scottish HBSC survey.

The Scottish study is based at the MRC/CSO Social and Public Health Sciences Unit (SPSHU), University of Glasgow and undertaken in collaboration with the School of Medicine, University of St Andrews. The SPHSU also hosts the HBSC International Coordinating Centre (ICC). The study is funded by Public Health Scotland.

HBSC Scotland data are also used to support school-based health improvement activities through the Scottish Schools Health and Wellbeing Improvement Research Network (SHINE), also based at the SPHSU, University of Glasgow. SHINE aims to support improvements in health and wellbeing amongst school-aged children by building a collaboration between schools, researchers and policy-makers, and HBSC data are used by schools in the network to help identify their key health and wellbeing needs.