Mental health of young people in Australia

7 Adolescent mental health problems, health-related quality of life and health-risk behaviour

Page last updated: October 2000

This chapter describes what adolescents themselves reported about their mental health problems, health-related quality of life and health-risk behaviour as well as the perceived barriers to services. It was considered important to obtain the views of adolescents directly because there is considerable evidence that their perceptions in these areas differ from those of their parents (Achenbach et al., 1987).

This chapter is divided into four sections. The prevalence of mental health problems reported by adolescents and their health-related quality of life (HRQL) are described in the first two sections. The relationship between mental health problems and adolescent health-risk behaviour is described in the third section. In each of these sections, the definition of mental health problems and the methods used to describe the association between mental health problems, HRQL and health-risk behaviour are the same as those used with the parental reports (see chapter 3 and chapter 5). For brevity, details of the methodology are not repeated in this chapter. The final section describes the barriers to service use identified by adolescents.

Prevalence of adolescent mental health problems
Health-related quality of life
Health-risk behaviour
Barriers to service use
Summary

Prevalence of adolescent mental health problems

Nineteen percent of adolescents scored in the clinical range on the Total Problems scale of the Youth Self-Report (table 7.1). On the Externalising scale, 23% of females and 17% of males scored in the clinical range. A similar percentage (16%) of males and females scored in the clinical range on the Internalising scale. In table 7.2 it can be seen that 12% of adolescents scored in the clinical range on the Delinquent Behaviour scale, 8% on the Aggressive Behaviour scale, and 7% on the Attention Problems scale. For reasons described in chapter 3, the comparison between genders was repeated using average scores. This comparison showed that the typical number of externalising problems reported by males varied little from that reported by females; however, females were more likely to report internalising problems (see table A.3 & table A.4 in appendix A).

In some areas the proportion of adolescents scoring in the clinical range varied from that identified by parents. For example, when information was obtained from adolescents rather than parents, substantially more scored in the clinical range on the Delinquent Behaviour scale (12% versus 6%) and on the Anxious/Depressed scale (7% versus 4%). These differences suggest that adolescents may be more aware of some problems than their parents.
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Table 7.1 Prevalence (%) of total problems, externalising problems and internalising problems reported by adolescents (13–17 years)

Total problems
%
Total problems
Population estimatea
Externalising problems
%
Externalising problems
Population estimate
Internalising problems
%
Internalising problems
Population estimate
All adolescents
19.0
251,020
19.7
260,268
16.5
217,991
Males
15.7
106,265
16.8
113,710
16.3
110,326
Females
22.4
144,326
22.6
145,615
16.6
106,956

a estimated number of adolescents with a mental health problem in Australia.

Table 7.2 Prevalence (%) of mental health problems in specific areas reported by adolescents (13–17 years)

Type of ProblemAll AdolescentsMalesFemales
Delinquent Behaviour
11.9
11.5
12.4
Aggressive Behaviour
7.6
6.2
9.1
Attention Problems
6.9
7.1
6.6
Anxious/Depressed
6.8
6.7
6.8
Somatic Complaints
6.5
6.3
6.6
Social Problems
3.5
3.4
3.5
Thought Problems
3.0
3.3
2.7
Withdrawn
3.0
3.1
2.9

Health-related quality of life

Adolescents who reported more emotional and behavioural problems also reported a less favourable HRQL in several areas of their lives (figure 7.1). For example, adolescents with more problems reported more pain and discomfort (possibly reflecting more frequent physical health problems - see p. 42), lower self-esteem and greater difficulty with school and peer activities due to emotional and behavioural problems than did adolescents who reported fewer problems.

Adolescents with more emotional and behavioural problems believed that their problems had a greater impact on family activities than did adolescents who reported fewer problems. They also reported living in less cohesive families than did adolescents with fewer problems (figure 7.2).

Figure 7.1 Health-related quality of life of adolescents according to adolescent reports

Refer to the following text for a text equivalent of Figure 7.1 Health-related quality of life of adolescents according to adolescent reports
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Text version of Figure 7.1

Figures in this description are approximate as they have been read from the graph.

The figure shows the the average CHQ score (higher is better HRQL, lower is worse HRQL) for children and adolescents with low, moderate, high and very high levels of emotional and behavioural problems. The average scores are presented in the following table
Low level
of problems
Moderate level
of problems
High level
of problems
Very high level
of problems
Physical activities
96
94
92
90
Pain & discomfort
87
77
67
62
School/friends - physical limitations
98
96
93
89
School/friends - emotional limitations
96
91
84
72
School/friends - behavioural limitations
98
95
88
79
Self-esteem
85
75
64
57

Figure 7.2 Family functioning according to adolescent reports

Refer to the following text for a text equivalent of Figure 7.2 Family functioning according to adolescent reports
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Text version of Figure 7.2

Figures in this description are approximate as they have been read from the graph.

The figure shows the the average CHQ score (higher is better functioning, lower is worse functioning) for children and adolescents with low, moderate, high and very high levels of emotional and behavioural problems. The average scores are presented in the following table.
Low level
of problems
Moderate level
of problems
High level
of problems
Very high level
of problems
Family activities
91
81
73
63
Family cohesion
81
70
63
51

Health-risk behaviour

The Youth Risk Behaviour Questionnaire, which was completed by adolescents participating in the survey, provides information about suicidal ideation and suicidal behaviour, drug use, and behaviour relevant to eating and body weight (Brener et al., 1995). The rates of health-risk behaviour reported by male and female adolescents are shown in table 7.3. These results are consistent with those of previous studies, which found higher rates of suicidal ideation and behaviour among females. Females also reported much higher rates of behaviour designed to lose or control their weight.

Table 7.3 Prevalence (%) of health-risk behaviour reported by adolescents

Table 7.3 is separated into 4 smaller tables in this HTML version for accessibility reasons. It is presented as one table in the PDF version.

Suicidal ideation and suicidal behaviour

Risk behaviourAll adolescentsMalesFemales
Suicidal ideation
12.0
10.2
13.8
Suicide plan
8.9
7.4
10.5
Suicide attempt
4.2
2.7
5.7
Suicide attempt requiring treatment
0.9
1.2
0.5

Smoking, alcohol and marijuana use

Risk behaviourAll adolescentsMalesFemales
Smoking
23.1
20.8
25.3
Drinking
36.7
34.7
38.7
Great than or equal to 5 drinks in a row
20.4
20.1
20.8
Marijuana use
11.0
11.3
10.8
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Dieting and exercise behaviour

Risk behaviourAll adolescentsMalesFemales
Dieting to control weight
16.8
7.4
26.1
Exercising to control weight
36.2
25.5
46.9
Losing weight by vomiting/laxatives
1.9
0.8
3.0
Losing weight by taking pills
0.6
0.3
0.9

Physical health preceptions

Risk behaviourAll adolescentsMalesFemales
Problems in last 6 months
17.5
15.2
19.8
Problems compared to peers
7.2
6.3
8.2
Professional help needed
7.4
6.4
8.4
Help received
6.0
5.3
6.7

(i) Suicidal ideation and behaviour

Adolescents were asked if, during the past 12 months, they had:
  1. seriously considered attempting suicide,
  2. made a plan to attempt suicide,
  3. actually attempted suicide, or
  4. made a suicide attempt resulting in an injury, poisoning or overdose that had to be treated by a doctor or nurse.
Adolescents with more emotional and behavioural problems reported substantially more suicidal ideation and behaviour (figure 7.3). For example, 42% of adolescents with a very high level of problems reported that they had seriously considered suicide; in contrast, only 2% of adolescents with a low level of problems had considered suicide. Similarly, 25% of adolescents with a very high level of emotional and behavioural problems reported making a suicide attempt during the previous 12 months as compared to fewer than 1% of adolescents with a low level of problems. Eleven adolescents (1%) reported that they had made a suicide attempt in the last 12 months that had required medical or nursing attention. All these adolescents reported a high or very high level of emotional and behavioural problems.
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Figure 7.3 Suicide ideation and suicidal behaviour

Refer to the following text for a text equivalent of Figure 7.3 Suicide ideation and suicidal behaviour
Text version of Figure 7.3
Figures in this description are approximate as they have been read from the graph.
Low level of
emotional & behavioural problems (%)
Moderate level of
emotional & behavioural problems (%)
High level of
emotional & behavioural problems (%)
Very high level of
emotional & behavioural problems (%)
Suicide ideation
4
8
23
42
Suicide plan
3
7
15
32
Suicide attempt
1
3
7
23
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(ii) Drug use

Adolescents were asked about their use during the previous 30 days of:
  • cigarettes,
  • alcohol,
  • marijuana, and
  • other drugs such as LSD, amphetamines, heroin and cocaine.
Adolescents with more problems reported smoking cigarettes more frequently than did those with fewer problems (figure 7.4). For example, 54% of the adolescents who reported a very high level of problems also reported smoking during the previous 30 days, compared to only 11% of adolescents with a low level of problems. A similar pattern was evident with alcohol use, although the difference between adolescents with low and high levels of problems was smaller than it was with smoking. Finally, adolescents with more problems reported using marijuana more often than did adolescents with fewer problems.

Adolescents also reported using a range of other drugs over their lifetimes. These included inhalants (9%), pain killers for non-medical purposes (8%), prescription drugs for non-medical purposes (4%), hallucinogenics (4%), cocaine (3%), amphetamines (3%), designer drugs (1%) and heroin (1%). Adolescents with a higher level of problems consistently reported more frequent use of these drugs. For example, 23% of the adolescents who reported a very high level of problems also reported using pain killers for non-medical purposes, compared to only 3% of adolescents with a low level of problems.

Figure 7.4 Smoking, alcohol use and marijuana use

Refer to the following text for a text equivalent of Figure 7.4 Smoking, alcohol use and marijuana use
Text version of Figure 7.4
Figures in this description are approximate as they have been read from the graph.
Low level of
emotional & behavioural problems (%)
Moderate level of
emotional & behavioural problems (%)
High level of
emotional & behavioural problems (%)
Very high level of
emotional & behavioural problems (%)
Smoking
11
25
33
54
Drinking
26
41
52
47
Greater than or equal to 5 drinks in a row
13
23
31
31
Marijuana use
4
12
19
23
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(iii) Body weight

Adolescents were asked if they had engaged in any of the following behaviour to lose or control their weight during the past 30 days:
  1. dieting,
  2. exercising,
  3. vomiting or taking laxatives, or
  4. using diet pills.
Adolescents who reported more emotional and behavioural problems were more likely to report that they had dieted or exercised to lose or control their weight than were adolescents with fewer problems (figure 7.5). Furthermore, adolescents with a very high level of problems reported more frequently that they vomited or took laxatives to control or lose weight.

Figure 7.5 Dieting and exercise behaviour

Refer to the following text for a text equivalent of Figure 7.5 Dieting and exercise behaviour
Text version of Figure 7.5
Figures in this description are approximate as they have been read from the graph.
Low level of
emotional & behavioural problems (%)
Moderate level of
emotional & behavioural problems (%)
High level of
emotional & behavioural problems (%)
Very high level of
emotional & behavioural problems (%)
Dieting to control weight
9.5
19
21
36
Exercising to control weight
30
38
43
47
Losing weight by vomiting/laxatives
1
3
2
9
Losing weight by taking pills
0
2.5
2
3
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(iv) Physical health

Adolescents were asked if, during the past six months, they:
  1. had any physical health problems,
  2. had more physical health problems than other adolescents their age,
  3. needed help for physical health problems, or
  4. received help for physical health problems.
Adolescents with more emotional and behavioural problems reported more problems with their physical health (Figure 7.6). In each group, a similar percentage reported that they needed professional help for their problems. However, substantially fewer adolescents with a very high level of problems reported that they had received help.

Figure 7.6 Physical health


Refer to the following text for a text equivalent of Figure 7.6 Physical health
Text version of Figure 7.6
Figures in this description are approximate as they have been read from the graph.
Low level of
emotional & behavioural problems (%)
Moderate level of
emotional & behavioural problems (%)
High level of
emotional & behavioural problems (%)
Very high level of
emotional & behavioural problems (%)
Problems in last 6 months
8
20
27
38
Problems compared to peers
34
45
37
58
Professional help needed
38
51
45
44
Help received
77
71
84
42
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Barriers to service use

Adolescents with mental health problems gave somewhat different reasons than their parents for not attending services (figure 7.7). For example, 14% of adolescents reported being worried about what other people would think of them if they sought help. Thirty-eight percent of adolescents reported that they preferred to manage their own problems. Other major barriers identified by adolescents were thinking nothing could help (18%) and not knowing where to get help (17%).

Figure 7.7 Barriers to obtaining help

Refer to the following text for a text equivalent of Figure 7.7 Barriers to obtaining help

Text version of Figure 7.7

Figures in this description are approximate as they have been read from the graph.

Barriers to obtaining help:
  • Preferred to mange self - 39%
  • Didn't think anyone could help - 18%
  • Didn't know where to get help - 16%
  • Afraid of what people think - 14%
  • Other reason - 12%
  • Had to wait a long time - 0%
  • Services too far away - 0%
  • Asked for help but didn't get it - 0%
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Summary

Three key findings are reported in this chapter. First, adolescents reported a high prevalence of mental health problems. This is consistent with reports from their parents. Second, there was a strong association between the number of emotional and behavioural problems reported by adolescents and their perceptions of their health-related quality of life. For example, adolescents with more emotional and behavioural problems reported lower self-esteem and more difficulties in activities at school and with peers. Once again, this pattern is consistent with that reported by parents. Finally, there was a strong association between the presence of mental health problems and health-risk behaviour such as suicidal ideation and behaviour, smoking, and drug and alcohol abuse.

There are some striking findings in the analyses that focus on the relationship between the frequency of emotional and behavioural problems and health-risk behaviour. For example, 50% of adolescents with a high level of problems reported smoking or drinking during the previous month. Furthermore, 30% of adolescents in this group reported at least one episode of binge drinking during the previous month (i.e., consuming five or more drinks of alcohol within a couple of hours). A substantial number of adolescents with mental health problems behave in a manner that places them at risk for other health problems. In light of this tendency, it is not surprising that adolescents with a high level of emotional and behavioural problems reported more problems with their physical health. Of particular concern is the relatively low number of these adolescents who had received help for their problems.

The strong association between mental health problems and suicidal behaviour or ideation is consistent with results from several previous studies (Andrews & Lewinsohn, 1992; Graham et al., 2000). Suicide is a major cause of death among adolescents in Australia, particularly among males. There is evidence that adolescents with higher rates of suicidal ideation and behaviour are at a markedly greater risk of death by suicide. The high rates of suicidal ideation and behaviour identified among adolescents with a high level of problems suggests that they should be an important target group for programs designed to reduce suicide.

Traditionally, health services have tended to focus their attention on a particular problem. For example psychiatric services focus on mental health, drug and alcohol services on drug and alcohol abuse, and paediatric services on physical health. Furthermore, as Andrews et al. (2000) have pointed out, clinical practice guidelines often concentrate on the management of a single mental disorder. This narrow approach, however, does not reflect the complexity of health problems experienced by adolescents, as young people with a high level of problems in one area often experience difficulties in other areas of their lives. Individual professions and services must pay more attention to the high levels of comorbid problems in young people, and they need to develop strong collaborative relationships with each other if they are to provide adolescents with effective help for their problems. Financial incentives should be used to encourage health services to broaden their treatment programs and improve coordination with other services. Further research is also needed to provide a better understanding of the mechanisms that give rise to the broadly based problems experienced by adolescents.