Changes in millennial adolescent mental health and health-related behaviours over 10 years: a population cohort comparison study

Background There is evidence that mental health problems are increasing and substance use behaviours are decreasing. This paper aimed to investigate recent trends in mental ill health and health-related behaviours in two cohorts of UK adolescents in 2005 and 2015. Methods Prevalences in mental health (depressive symptoms, self-harm, anti-social behaviours, parent-reported difficulties) and health-related behaviours (substance use, weight, weight perception, sleep, sexual intercourse) were examined at age 14 in two UK birth cohorts; Avon Longitudinal Study of Parents and Children (ALSPAC, N = 5627, born 1991–92) and Millennium Cohort Study (MCS, N = 11 318, born 2000–02). Prevalences and trend estimates are presented unadjusted and using propensity score matching and entropy balancing to account for differences between samples. Results Depressive symptoms (9% to 14.8%) and self-harm (11.8% to 14.4%) were higher in 2015 compared with 2005. Parent-reported emotional difficulties, conduct problems, hyperactivity and peer problems were higher in 2015 compared with 2005 (5.7–8.9% to 9.7–17.7%). Conversely, substance use (tried smoking, 9.2% to 2.9%; tried alcohol, 52.1% to 43.5%, cannabis, 4.6% to 3.9%), sexual activity (2% to 0.9%) and anti-social behaviours (6.2–40.1% to 1.6–27.7%) were less common or no different. Adolescents in 2015 were spending less time sleeping (<8 h 5.7% to 11.5%), had higher body mass index (BMI) (obese, 3.8% to 7.3%) and a greater proportion perceived themselves as overweight (26.5% to 32.9%). The findings should be interpreted bearing in mind limitations in ability to adequately harmonize certain variables and account for differences in attrition rates and generalizability of the two cohorts. Conclusions Given health-related behaviours are often cited as risk factors for poor mental health, our findings suggest relationships between these factors might be more complex and dynamic in nature than currently understood. Substantial increases in mental health difficulties, BMI and poor sleep-related behaviours highlight an increasing public health challenge

The impact of sexual violence in mid-adolescence on mental health: a UK population-based longitudinal study

Summary Background A large gender gap appears in internalising mental health conditions during adolescence, with higher rates in girls than boys. There is little high-quality longitudinal population-based research investigating the role of sexual violence experiences, which are disproportionately experienced by girls. We aimed to estimate the effects of sexual violence experienced in mid-adolescence on mental health outcomes. Methods In this study, we used data from the longitudinal UK Millennium Cohort Study, a large nationally representative cohort of children born in the UK in 2000–02, for participants with information available at age 17 years on sexual violence in the past year (eg, sexual assault or unwelcome sexual approach), mental health outcomes (eg, completion of the Kessler Psychological Distress K6 scale in the past 30 days, self-harm in the past year, and lifetime attempted suicide). Multivariable confounder adjusted regressions and propensity matching approaches were used, and population attributable fractions (PAFs) were calculated. Findings We included 5119 girls and 4852 boys (8063 [80·8%] of whom were White) in the full analysis sample. In the fully adjusted model, compared with no sexual violence, sexual violence was associated with greater mean psychological distress in girls (mean difference 2·09 [95% CI 1·51–2·68]) and boys (2·56 [1·59–3·53]), higher risk of high psychological distress in girls (risk ratio [RR] 1·65 [95% CI 1·37–2·00]) and boys (1·55 [1·00–2·40]), higher risk of self-harm in girls (RR 1·79 [1·52–2·10]) and boys (RR 2·16 [1·63–2·84]), and higher risk of attempted suicide in girls (RR 1·75 [1·26–2·41]) and boys (RR 2·73 [1·59–4·67]). PAF estimates suggest that, in a hypothetical scenario with no sexual violence, the prevalence of adverse mental health outcomes at age 17 years would be 3·7–10·5% lower in boys and 14·0–18·7% lower in girls than the prevalence in this cohort. Interpretation Reductions in sexual violence via policy and societal changes would benefit the mental health of adolescents and might contribute to narrowing the gender gap in internalising mental ill health. Clinicians and others working to support adolescents should be aware that sexual violence has a widespread, gendered nature and an impact on mental health. Funding UK Medical Research Council

Sexual identity data collection and access in UK population-based studies

Sexual minority research in the UK has been underfunded and frequently stigmatised.1 Nonetheless, researchers have identified multiple health inequities, including in mental health and chronic disease, with the National Health Service England calling for the development of this evidence base since 2018

Measuring mental health and wellbeing outcomes for children and adolescents to inform practice and policy:a review of child self-report measures

There is a growing appetite for mental health and wellbeing outcome measures that can inform clinical practice at individual and service levels, including use for local and national benchmarking. Despite a varied literature on child mental health and wellbeing outcome measures that focus on psychometric properties alone, no reviews exist that appraise the availability of psychometric evidence and suitability for use in routine practice in child and adolescent mental health services (CAMHS) including key implementation issues. This paper aimed to present the findings of the first review that evaluates existing broadband measures of mental health and wellbeing outcomes in terms of these criteria. The following steps were implemented in order to select measures suitable for use in routine practice: literature database searches, consultation with stakeholders, application of inclusion and exclusion criteria, secondary searches and filtering. Subsequently, detailed reviews of the retained measures’ psychometric properties and implementation features were carried out. 11 measures were identified as having potential for use in routine practice and meeting most of the key criteria: 1) Achenbach System of Empirically Based Assessment, 2) Beck Youth Inventories, 3) Behavior Assessment System for Children, 4) Behavioral and Emotional Rating Scale, 5) Child Health Questionnaire, 6) Child Symptom Inventories, 7) Health of the National Outcome Scale for Children and Adolescents, 8) Kidscreen, 9) Pediatric Symptom Checklist, 10) Strengths and Difficulties Questionnaire, 11) Youth Outcome Questionnaire. However, all existing measures identified had limitations as well as strengths. Furthermore, none had sufficient psychometric evidence available to demonstrate that they could reliably measure both severity and change over time in key groups. The review suggests a way of rigorously evaluating the growing number of broadband self-report mental health outcome measures against standards of feasibility and psychometric credibility in relation to use for practice and policy

Predictors of mental health difficulties and subjective wellbeing in adolescents: A longitudinal study

BACKGROUND: Mental health and subjective well-being are of great interest in both health policy and research. There has been considerable debate regarding whether mental health difficulties and subjective wellbeing are two distinct domains or different ends of a single mental health spectrum. This study investigates if predictors of mental health difficulties and subjective wellbeing are the same or different in a large-scale community-based sample in the United Kingdom. METHODS: 13,500 adolescents in year 7 (aged 11-12) and again in year 8 (aged 12-13) completed surveys on emotional strengths and skills, support networks, mental health difficulties and wellbeing. Socio-demographic factors were gathered from the National Pupil Database. Mental health difficulties and wellbeing scores were standardized to allow comparisons. RESULTS: The correlation between mental health difficulties and subjective wellbeing was -0.48, indicating a moderate overlap between the two domains. Some of the predictors (e.g., gender, ethnicity, problem solving, emotion regulation) in year 7 predicted both mental health difficulties and subjective wellbeing in year 8. However, some of the predictors in year 7 only predicted mental health difficulties (e.g., special education needs, empathy) and some only subjective wellbeing (e.g., prosocial behaviour, peer support) in year 8. CONCLUSION: This study provides further evidence for differences in what predicts adolescents' mental health difficulties and subjective wellbeing. It highlights the importance of not only focusing on preventing or treating symptoms of mental illness but also focusing on improving children's wellbeing

Medically assisted reproduction and mental health in adolescence: evidence from the UK Millennium Cohort Study

BACKGROUND: The number and proportion of children conceived through medically assisted reproduction (MAR) is steadily increasing yet the evidence on their mental health in adolescence is inconclusive. Two main mechanisms with opposite effects can explain differences in mental health outcomes by conception mode: while more advantaged parental characteristics could positively influence it, higher parental stress could have a negative influence. METHODS: Linear and logistic estimations on a longitudinal population-based birth cohort study of 9,897 individuals to investigate whether adolescents conceived through MAR are more likely than naturally conceived (NC) children to experience mental health problems at age 17, as reported by adolescents themselves and their parents. We test whether this association is confounded and/or mediated by parental background characteristics collected when the cohort member was around 9 months old (maternal age, maternal education level, ethnicity, income quintile), family structure variables measured in adolescence (number of siblings in the household at age 15, parental household structure at age 14) or maternal distress at age 14. RESULTS: Children conceived naturally and through MAR self-reported similar mental health outcomes. The only differences between MAR and NC adolescents are in the parental reports, with parents who conceived through MAR reporting their children had 3.82 (95% CI: 1.140 to 11.54) and 2.35 (95% CI: 1.145 to 4.838) higher odds of falling within the high category of SDQ total difficulties and emotional symptoms scales, respectively. The results did not change on adjustment for mediators, such as maternal distress, number of siblings in the household and parental household structure. CONCLUSIONS: The results reveal a lack of or small differences in MAR adolescents' mental health outcomes compared to children who were conceived naturally. While the results based on the parental reports could suggest that MAR adolescents are at higher risk of suffering from mental health problems, the differences are small and not supported by adolescents' own reports. The difference between MAR and NC adolescent's parental report might reflect differences in parental concern, their relationship or closeness and can help to reconcile the mixed findings of previous studies

Assessing the readability of the self-reported Strengths and Difficulties Questionnaire

The Strengths and Difficulties Questionnaire (SDQ) is one of the most widely used measures in child and adolescent mental health in clinical practice, community-based screening and research. Assessing the readability of such questionnaires is important as young people may not comprehend items above their reading ability when self-reporting. Analyses of readability in the present study indicate that the self-report SDQ might not be suitable for young people with a reading age below 13–14 years and highlight differences in readability between subscales. The findings suggest a need for caution in using the SDQ as a self-report measure for children below the age of 13, and highlight considerations of readability in measure development, selection and interpretation

Socio-economic inequalities in adolescent mental health in the UK: Multiple socio-economic indicators and reporter effects

There are socio-economic inequalities in the experience of mental ill-health. However, less is known about the extent of inequalities by different indicators of socio-economic position (SEP). This is relevant for insights into the mechanisms by which these inequalities arise. For young people's mental health there is an additional layer of complexity provided by the widespread use of proxy reporters. Using data from the UK Millennium Cohort Study (N ​= ​10,969), we investigated the extent to which five SEP indicators (parent education, household income, household wealth, parent occupational status, and relative neighbourhood deprivation) predict adolescent internalising mental health (at ages 14 and 17 years) and how this varies as a function of reporter. Both parent report and adolescent self-report were considered. Regression models demonstrated that whilst greater disadvantage in all five SEP indicators were associated with greater parent-reported adolescent mental health symptoms, only income, wealth, and occupational status were associated with self-reported mental health symptoms at ages 14 and 17 years. The magnitude of these effects was greater for parent-reported than self-reported adolescent internalising symptoms: SEP indicators jointly predicted 4.73% and 4.06% of the variance in parent-reported symptoms at ages 14 and 17 compared to 0.58% and 0.60% of the variance in self-reported internalising mental health. Household income predicted the most variance in parent reported adolescent internalising symptoms (2.95% variance at age 14 & 2.64% at age 17) and wealth the most for self-reported internalising symptoms (0.42% variance at age 14 & 0.36% at age 17). Interestingly, the gradient and variance explained of parent-reported adolescent mental health across SEP indicators mirrors that of parent's own mental health (for example, income explained 4.89% variance at the age 14 sweep). Our findings highlight that the relevance of different SEP indicators to adolescent internalising mental health differs between parent and adolescent reports. Therefore, it is important to consider the various perspectives of mental health inequalities gained from different types of reporter

Change in device-measured physical activity assessed in childhood and adolescence in relation to depressive symptoms: a general population-based cohort study

Aim: Evidence for a link between physical activity and mental health in young people is hampered by methodological shortcomings. Using repeat assessments of device-measured physical activity, we examined the association of within-individual variation in free-living activity over 7 years with depressive symptoms. Methods: This was a prospective cohort study of a nationally representative sample of children born in the UK (n=4898). Physical activity was quantified using accelerometry at ages 7 and 14. The main outcome was depressive symptoms, based on the Short Mood and Feelings Questionnaire, assessed at age 14. Results: After adjustment for socioeconomic status, body mass index and psychological problems at baseline, a higher level of light-intensity activity at age 7 in girls was associated with a lower likelihood of having depressive symptoms at follow-up (OR, 0.79; 95% CI 0.61 to 1.00), although no associations were observed for moderate to vigorous activity or sedentary behaviour. Girls who transitioned from low baseline activity to higher levels at follow-up experienced a lower risk of depressive symptoms (OR, 0.60; 95% CI 0.39 to 0.92) compared with the inactive reference category. Null associations were observed in boys. Participants who consistently met the current recommendation of 60 min/day of moderate to vigorous activity both at 7 and 14 years of age experienced the lowest risk of depressive symptoms (OR, 0.55; 95% CI 0.34 to 0.88). Conclusion: To prevent depressive symptoms in adolescence, policies to increase physical activity from mid-childhood may have utility

Lifecourse investigation of the cumulative impact of adversity on cognitive function in old age and the mediating role of mental health: longitudinal birth cohort study

Objective: To investigate the accumulation of adversities (duration of exposure to any, economic, psychosocial) across the lifecourse (birth to 63 years) on cognitive function in older age, and the mediating role of mental health. // Design: National birth cohort study. // Setting: Great Britain. // Participants: 5362 singleton births within marriage in England, Wales and Scotland born within 1 week of March 1946, of which 2131 completed at least 1 cognitive assessment. // Main outcome measures: Cognitive assessments included the Addenbrooke’s Cognitive Examination-III, as a measure of cognitive state, processing speed (timed-letter search task), and verbal memory (word learning task) at 69 years. Scores were standardised to the analytical sample. Mental health at 60–64 years was assessed using the 28-item General Health Questionnaire, with scores standardised to the analytical sample. // Results: After adjusting for sex, increased duration of exposure to any adversity was associated with decreased performance on cognitive state (β=−0.39; 95% CI −0.59 to –0.20) and verbal memory (β=−0.45; 95% CI −0.63 to –0.27) at 69 years, although these effects were attenuated after adjusting for further covariates (childhood cognition and emotional problems, educational attainment). Analyses by type of adversity revealed stronger associations from economic adversity to verbal memory (β=−0.54; 95% CI −0.70 to –0.39), with a small effect remaining even after adjusting for all covariates (β=−0.18; 95% CI −0.32 to –0.03), and weaker associations from psychosocial adversity. Causal mediation analyses found that mental health mediated all associations between duration of exposure to adversity (any, economic, psychosocial) and cognitive function, with around 15% of the total effect of economic adversity on verbal memory attributable to mental health. // Conclusions: Improving mental health among older adults has the potential to reduce cognitive impairments, as well as mitigate against some of the effect of lifecourse accumulation of adversity on cognitive performance in older age