Tag Archives: Mental health

Taking time out to scroll free

As the Royal Society for Public Health launches its #ScrollFreeSeptember campaign, encouraging people to take a break from social media, Professor Yvonne Kelly from the ESRC International Centre for Lifecourse Studies at UCL, discusses new research on the negative impacts of social media use on young people’s health. She explains how the findings point to the need to limit the time that young people, especially girls, spend on social media.

The ScrollFreeSeptember campaign accompanies the launch of a second parliamentary inquiry in less than 12 months into the impact of social media use on young people’s mental health and well-being. Our Centre will be submitting a range of important new findings to that inquiry which seeks to grow the evidence base in an area where there is a great deal of hot debate, but where little is really known and understood.

For our team of researchers, the first indication that all was not well in the world of social media and young people’s mental health came in 2015 when we found that children who were heavy users of screen-based media were less happy and had more social and emotional problems than their peers who used it moderately. Children who used social media sites for chatting were also less likely to be happy and more likely to have problems than their peers who did not.

In March this year, our widely covered work on the trends for boys’ and girls’ social media use added weight to recent calls from the Children’s Commissioner for England to, as she put it, call time on a “life of likes”. In her report, Anne Longfield argued that there was clear evidence of children finding it hard to manage the impact of online life. She said children as young as eight were becoming anxious about their identity as they craved social media likes and comments for validation.

Social media and girls

Our research, based on the experiences of 10,000 children aged 10-15 who took part in the Understanding Society study, showed that this seemed to be the case particularly for girls who used social media for more than an hour a day. 10 year-old girls in the study who spent an hour or more on a school day chatting online had considerably more social and emotional problems later on – by age 15 – than girls of the same age who spent less or no time on social media. The number of problems they faced also increased as they got older, which was not the case for boys.

It was interesting to note that more girls than boys were using social media and for greater periods of time. At age 15, 43 percent of girls and 31 per cent of boys were using it for between one and three hours per day, with 16 and 10 per cent using it for more than four hours.

We think this tells us something important about the different ways that girls and boys interact with social media. For example, girls may be more likely than boys to compare their lives with those of friends and peers – whether those are ‘filtered’ selfies or positive posts about friendships, relationships or material possessions – these could lead to feelings of inadequacy, lower levels of satisfaction and poorer wellbeing.

The pressures associated with having peers like or ‘approve’ status updates and a perceived fall in or lack of popularity could add further pressure at, what for many teenagers is a tricky time in their lives.

Boys are more likely to be gaming than interacting online in the way just described and that wasn’t covered in this research, so it’s possible that for boys, changes in well-being may be more related to gaming success or skill.

But one of the key takeaways of this research is how social media use as a very young person is linked to lower levels of happiness later on – the effects are not short term – they have longer term consequences and

Social media and depression

More recently, we have turned our attention to the social media experiences of the children in the Millennium Cohort Study (MCS), using information on 11,000 14 year-olds to look at how social media use is linked with depression. We’ve also been asking ourselves what the pathways between these two things might look like, something that’s not really been done before. So, for example, are heavier users of social media getting too little sleep or having trouble getting to sleep because they are checking accounts at bedtime; are they experiencing cyberbullying either as victims or perpetrators; do they appear to have low self-esteem or a negative view of how they look? All these questions can help us better understand what’s at play and come up with better approaches to tackling these problems.

Preliminary findings reinforce the message that girls are particularly vulnerable to the negative effects of social media. Once again we see more girls than boys in this study using social media and for longer periods of time.

Does using social media affect literacy?

A follow up piece of research looks at whether there are links between the amount of time young people spend on social media and their levels of literacy. Findings suggest a link and that this is the same for boys and girls.

In this research we look at whether the more time young people spend on social media, the less time they have for the things that might improve their literacy such as reading for enjoyment and doing homework.

There are some clear messages from our research so far:

  1. Heavy users of social media are less happy and have more problems at school and at home – interventions to help them limit and manage their social media use better are likely to be important
  2. Girls are particularly vulnerable to the negative effects of social media and may be an important group to focus on among those looking to mitigate thse effects
  3. More hours spent on social media appear to impact negatively on young people’s wellbeing and could have knock on effects for their longer term prospects at school and work

Social media companies have been accused by the former Health Secretary Jeremy Hunt among others of turning a blind eye to the problem and the chief medical officer Dame Sally Davies has been asked to recommend healthy limits for screen time.

Our research indicates that it may indeed be time for recommended healthy and safe limits of social media use, that a focus on girls, especially initiatives to boost their mental health could help mitigate some of the negative effects.

The RSPH is hoping that going scroll free this September might give us all a chance to get our social media use a little more balanced, to think about the benefits to be enjoyed and the negatives to be avoided.

As well as pausing to think about our social media use and how it affects us, it will be an opportunity to examine the facts of the matter, a time to digest new, solid evidence that these large scale studies can help us with and consider the potential longer term costs and consequences of doing nothing.

The forthcoming inquiry hopes to inform “progressive and practical solutions”, including a proposed industry Code of Practice and tools for educators, parents and young people themselves to help them enjoy the benefits and eliminate the negative effects of their social media. We wholly support those efforts and hope they result in positive changes that will make campaigns like ScrollFreeSeptember unnecessary in the future.

Time to ACE the way we measure the bad things that happen to children

Adverse Childhood Experiences (ACEs) have been a hot topic for policy work in child health and development in recent months. The Select Committee for Science and Technology announced an inquiry into evidence-based early-years interventions, with a particular focus on ACEs. Also a new All Party Parliamentary Group for the Prevention of Childhood Adversities was set up. Essential to the success of these policy initiatives is a fit for purpose method of measuring the negative things that happen to people when they are young, something Rebecca Lacey from the ESRC International Centre for Lifecourse Studies at University College London argues is often overlooked. As part of a new research project, she is hoping to change that.

When Norman Lamb MP launched the early-years intervention inquiry in late 2017, he expressed concern that research in this area was “not being effectively used” in the creation of health policy and other support arrangements. Part of the problem with effective evidence in this area is that the system used to ‘score’ the number of bad things that have happened to a child and assess their risk of poor outcomes later in life is often poorly thought through and rarely questioned.

In 1998 a landmark piece of research by Vincent Felitti and colleagues showed that adults who reported being abused as children, witnessing violence against their mother, living with a substance misuser, or someone who had been in prison or had a mental illness had an increased risk of numerous health problems, such as depression and drug misuse, when they grew up.

It also showed that the number of adversities that someone reported having experienced as a child was really important; the more adversities reported, the higher the risk of health problems in adulthood. This number of adversities is often known as an ‘ACE score’ and Felitti’s paper was the first to use this approach for childhood adversities. It’s an approach that has since been employed in hundreds of academic studies.

Advantages and disadvantages

ACE scores have several advantages. They’re easy to calculate by simply adding up the number of adversities each person has experienced. In a clinical setting, a simple screening tool can be used to identify people at particularly high risk of health problems. These are generally people who have experienced four or more adversities, regardless of which ones.

This approach also acknowledges that people reporting one adversity are much more likely to have experienced at least one other. In Felitti’s study more than half of the people reporting that they’d been psychologically abused as a child had also been physically abused. Similarly, 3 out of every 5 people who had a family member in prison also reported that someone in the household had substance misuse problems. This clustering of adversities is crucially important to recognise both in research and in policymaking.

However, there are many reasons why ACE scores aren’t helpful for policy use. In fact they were never ‘designed’ with policy use in mind. Because they lump together adversities which are often very different (for example, experiencing abuse is likely to be a different experience to having a parent in prison), it’s difficult to tell which adversities have the potential to have the most harmful effects on health. We also don’t always know a lot about how those adversities affect health. Knowing this information would help us to better inform where to target policies. The problem is further confused by different studies including different adversities in their ACE score. So when looking at the findings of different studies you can be comparing apples and pears.

Policy relevance

The heightened interest in ACEs combined with the recognition that early life is important for how a person’s life will pan out is really good news. But we do need to think more carefully about how we measure adversities in research and in particular how we can make our research more policy relevant.

For instance, if there’s a limited budget, which adversities would you try to tackle first? Are there particular childhood adversities which increase the risk of a child experiencing many other adversities? How do different types of adversities affect health? Is it appropriate to lump together very different types of adversities into an ACE score or is there a more appropriate way of treating the clustering of adversities in a less crude way? These are just some of the questions that need to be addressed quickly.

 Whilst the research is underway, there are a few things that researchers and policymakers can think about. As a starting point researchers and policy makers and practitioners interested in this area need to think more critically about how adversities are measured, with an aim of being more meaningful and policy relevant. What do we and don’t we know by using ACE scores? What other approaches to adversity measurement could we explore?

Longitudinal studies are key

Longitudinal studies, such as the British Birth Cohorts, which collect information on children and their family circumstances over their lives, are key to improving the evidence base on ACEs and health. Many of the existing studies on ACEs and health have relied on people recalling information on what they experienced as a child. This is prone to error and bias, and can be affected by what people are experiencing at the time they are asked, such as depression or stress at work.

These studies can also help us better understand whether and how timing matters. Not only can we ask which adversities appear to be particularly harmful for health, but also, when exposure to specific adversities are particularly harmful. By doing this/taking this kind of approach, we can also identify the most fruitful times to intervene to help people flourish across their lives.

Finally, the communication of risk is really important. There are many advocates of ACEs who directly translate findings from observational, population-level research into their work with individuals. For instance, if a research study shows that children who experience 4 or more adversities are on average 6 times more likely to be depressed in adulthood, this doesn’t mean that every individual who experienced 4 adversities will be 6 times more likely to have depression in adulthood. This approach of directly translating population risk is not appropriate and if done means that research often gets miscommunicated in a way that’s too deterministic. The health (or other) consequences of ACEs are not inevitable.

The recent increase in policy interest gives us an opportunity to achieve a step-change in the way we look at adverse childhood experiences.  If we seize this opportunity, the research community can play a key role in supporting the desire of policy makers and politicians to be effective in achieving their aim of helping at-risk children, adults affected by earlier bad experiences, the NHS, all those working in this area and UK taxpayers.

Wheezing: Can breastfeeding for longer make a difference?

Public health bodies put a lot of effort into encouraging mothers to breastfeed, and for good reasons. Successive studies have shown breastfeeding has a range of health benefits, including a lower risk of wheezing illnesses, which can be linked to asthma. But which of these illnesses are most likely to respond? Is a breastfed child less likely to develop wheezing after age five, or age seven, for instance? Or is the protective effect mainly measurable only in younger children? Professor Maria Quigley from the National Perinatal Epidemiology Unit at the University of Oxford, along with colleagues at Oxford and UCL, has been looking at how and when breastfeeding is associated with wheezing.

Asthma is the most common chronic condition affecting children and young people in the UK. It’s the most common reason why children are admitted to hospital, and sadly each year a few still die from the condition. According to the British Lung Foundation three children in every hundred under the age of five have been diagnosed with asthma at some point; and by age 10 that figure rises to one in 10.

There’s no cure, and so the priority for public health bodies has been to understand the disease better, to manage it better and to learn more about the factors that can protect us from it. One such protective factor is breastfeeding: two recent pieces of research have shown there is a lower risk among breastfed children, but that the effect is stronger among the very young – both for asthma and for wheezing, which has many causes and which does not necessarily develop into asthma.

Childhood wheezing can follow a variety of patterns – it can set in early but clear up before adulthood, for instance, or it can start later but continue into later life. Some wheezing will start in childhood and will continue.

Millennium Cohort Study

We wanted to look at how breastfeeding might affect these different types, so we used data from the Millennium Cohort Study, which has followed the lives of almost 19,000 children born in the UK between September 2000 and January 2002. Their parents were interviewed when they were 9 months old, and again when they were 3, 5, 7 and 11 years.

Our study focused on just over 10,000 children who were seen at all of those points and who were the product of single as opposed to multiple birth. Mothers were asked whether they had tried to breastfeed, and for how long their children had been breastfed.

Among our sample, seven out of 10 children had been breastfed: a little more than one in ten of the study sample for less than a week; a fifth for between one and three weeks, just over one in six for three to six months and around a quarter for six to nine months.

We found that at age 9 months, 6.5 per cent of children had a history of wheezing. At age 3 years, 19.5 per cent had such a history in the past year. As the children got older, though, this proportion decreased – 16 per cent at age five, 11.8 per cent at age seven and 11.4 per cent at age 11.

Overall, 37 per cent of children had suffered from wheezing at least once between 9 months and 11 years. A little under a fifth (18.8 per cent) had wheezing at younger age which cleared up when they got older, while 6.2 per cent had wheezing which started later and 11.8 per cent had persistent wheezing.

Feeding and wheezing

When we looked at the association between breastfeeding and wheezing, we found the children who had been breastfed for longest were less likely to suffer from wheezing.

But this effect lessened with time. For example, those breastfed for six to nine months were less likely to wheeze between the ages of nine months and five years, but by the age of 11 this group had no significant advantage over those who were breastfed for less time.

What does our study tell us about the relationship between breastfeeding and wheezing? The picture is a complex one. There are many causes of wheezing and of asthma, and those causes change over time. So in order to draw firm conclusions about cause and effect, we would need a much more complex dataset. It would be interesting, for instance, to look at clinical information on children’s allergies or their lung function.

But what we can say is that age matters – in order to understand how breastfeeding affects the development of wheezing during childhood, we must take a longer and more nuanced view.

Breastfeeding And Childhood Wheeze: Age-Specific Analyses and Longitudinal Wheezing Phenotypes as Complementary Approaches To The Analysis Of Cohort Data is research by Maria Quigley (University of Oxford), Claire Carson (University of Oxford) and Yvonne Kelly (UCL). It is published in the American Journal of Epidemiology.

Equally protected children: one step closer

In 2015 UCL researchers Anja Heilmann, Yvonne Kelly and Richard Watt produced a report, which showed that there was ample evidence that physical punishment can damage children and escalate into physical abuse. Together with the children’s charities that commissioned the report, they called for urgent action to provide children with the same legal protection against violence that British adults enjoy. The report was at the heart of Scottish MSP John Finnie’s proposed Children (Equal Protection from Assault) Bill which the Scottish Government have just announced that they will support in their programme for the coming year. The Bill would make Scotland the first UK country to outlaw all physical punishment by removing the defence of “justifiable assault” of children, and giving them the same protection as adults. Lead researcher, Anja Heilmann, reflects on the news and what she hopes it might mean for the human rights of children in Scotland and elsewhere.

On 11 May 2017, John Finnie MSP proposed a Bill to the Scottish Parliament to “give children equal protection from assault by prohibiting the physical punishment of children by parents and others caring for or in charge of children”.

After a three month consultation, which received more than 650 responses, the majority positive (75 per cent), that Bill became part of the Scottish Government’s plans for the next year, as Nicola Sturgeon announced she would not oppose it.

If passed, the Bill will prohibit the physical punishment of children by ending the existing common-law position that physical punishment by parents can be defended as reasonable chastisement and therefore be lawful. The Bill will not create a new criminal offence, as the common law offence of assault will apply (with a modification removing the reasonable chastisement defence).

It’s a far cry from similar efforts made in Scotland in 2002 to prohibit the physical punishment of children under the age of three. Back then, not only did a majority of MSPs reject the idea, but it was branded as “ridiculous” and an unwelcome intrusion into family life by many parents and the media.

15 years on it seems attitudes may have changed significantly. In the foreword to the Bill, John Finnie himself said:

“We would no longer consider it acceptable…. to allow our children to roam freely in the back of the car when going on a journey. Neither would we dream of taking them to a cinema if they had to watch a film through a fug of cigarette smoke … Attitudes towards these and many other fundamental societal issues have dramatically changed.”

Those attitudes changed as the result of a clear presentation of the evidence – the hard facts about the damage that those behaviours could cause.

We believe that, in this case, our evidence has made it clear for all to see that hitting children can not only damage them, but it carries the risk of escalation into physical abuse. It is a clear violation of international human rights law and children should and must be afforded the same rights as adults in this respect.

Overwhelming evidence

The evidence for the detrimental effects of physical punishment is vast and consistent. In short, our summary of the available evidence showed that physical punishment was related to increased aggression, delinquency and other anti-social behaviour over time. It also showed the more physical punishment suffered by a child, the worse the subsequent problem behaviour.

There was also a clear link between physical punishment and more serious child maltreatment and negative effects continued into adulthood, including problems of drug and alcohol dependency.

Half-hearted responses to recent human rights rulings condemning the physical punishment of children need to become wholehearted changes to the law, not tinkering that does just enough to meet the minimum requirements of those judgments rather than properly respect the rights of children.

The UN Committee on the Rights of the Child is unequivocal – all forms of corporal punishment of children are unacceptable. Let’s hope the Scottish Parliament can find the courage to make that statement a reality and show the rest of the UK the way.

As Martin Crewe of Barnardo’s Scotland stated:

“This is a huge step forward and sends a very clear message about the kind of Scotland we want to see for our children.”

Personally, I am hoping it’s a kind of Scotland and indeed UK, we WILL see in the not too distant future and I appeal to all MSPs to listen to the evidence and support the Bill.

Equally Protected? A review of the evidence on the physical punishment of children by Dr Anja Heilmann, Professor Yvonne Kelly and Professor Richard G Watt was commissioned by NSPCC Scotland, CHILDREN 1st, Barnardo’s Scotland and the Children and Young People’s Commissioner Scotland.

Do mental health problems have their roots in the primary school years?

Recent reports have shown worrying rises in young people suffering from mental health problems. A study for the Department of Education showed more than a third of teenage girls reporting depression, anxiety and low self-esteem. To try to understand this growing problem, Dr Afshin Zilanawala and fellow researchers from the ESRC International Centre for Lifecourse Studies at UCL have investigated how certain aspects of learning in the primary school years and success affect the behaviour and wellbeing of early adolescents.

Young people who drink, smoke and have behavioural problems are known to be at risk of suffering poor health as adults.

Understanding what causes this risky behaviour, and the anxiety and low self-esteem associated with it, can help professionals to target those most likely to drop out of school, become pregnant as a teenager, become obese or to suffer other long-term health issues.

By planning support and prevention programmes during childhood, they can improve the likelihood of a successful and healthy adulthood for our most vulnerable young people, and reduce the pressure on health and social services.

Mental health

A recent YouGov survey of Britain’s university students revealed that more than a quarter of them report depression and poor mental health.

But could the roots of these problems be found by looking more closely at how children develop and learn throughout the primary school years?

Information on more than 11,000 children collected by the UK Millennium Cohort Study (MCS) was used in our research, which explores the links between children’s verbal abilities and their behaviour and well-being as they make the move to secondary school.

Using information collected at ages three, five, seven and 11, we were able to see how well they could read, the range of their vocabulary and their verbal reasoning skills.

Then, at age 11, the children were asked about their school work and life, their family and friends and their appearance. There were questions about how happy they were, whether they felt good about themselves. They were also asked if they had tried cigarettes or alcohol, and if they had stolen anything or damaged property.

Verbal performance

In terms of how well they were getting on, the children were divided into three groups (low, average and high verbal achievers).

This in itself produced a startling and worrying view of the diverging paths these different children follow over time, particularly between the ages of seven and 11. One in five of the children (the high achievers) did better and better at the verbal tests, stretching away from their peers as they prepared to head to secondary school. The majority (around three quarters) of children were on the middle path, making steady progress but then plateauing off. But, most striking of all was what happened to the low achieving group (around one in 17 of the children), whose verbal abilities declined steeply.

Verbal ability

Millennium Cohort Study

Having established these pathways, we went on to look at which children at age 11 were involved in risky behaviours and then to dig deeper to see how these behaviours related to their progress to date. We also looked at what other factors, especially those related to their family circumstances, might be at play.

Boys were more likely than girls to be smoking and drinking or getting involved in anti-social behaviour. Girls were more likely to suffer from low self-esteem. First-born children were happier and had higher self-esteem, and were less likely to smoke, drink and have problem behaviours than second or later birth-order children. Children with younger mums were also more likely to engage in risky behaviour.

Those from disadvantaged backgrounds and those with more unsupervised time were more likely to suffer from poor mental health. We also found those whose mothers suffered from depression were more at risk of mental health problems.

Looking at the raw data, the low achieving children were three times more likely to smoke than their high achieving peers and twice as likely as the average group. Low achieving and average achieving children were also more likely to drink.

One in three of the low achieving children compared with one in five of the high achievers had been involved in anti-social behaviour and were more than four times more likely to have behaviour problems as reported by their parent. They also had much lower levels of self esteem.

Family factors

When we took a range of family factors into account including the child’s age and gender, mother’s age and mental health and socioeconomic circumstances, many or all of the differences between the groups disappeared or became smaller, confirming the overriding importance of the family and social environment.

However, we can say, for the first time, and with considerable confidence, that how well children are reading, talking and reasoning, can and does influence their health and well-being as they become adolescents. Indeed, we found clear evidence that children who were performing below average in this area across childhood were more at risk of poor mental health and risky behaviour than their consistently above-average performing peers.

If we want those children to stand a better chance of a healthy and happy life, we need to focus a great deal of attention on what is happening at home and at school in those early years, particularly, our research would seem to show, between the ages of 7 and 11.

Our results are consistent with other research, which demonstrates the huge challenge for young people with poor verbal skills, who arrive at the doorstep of adolescence with mental health, self-esteem and behavioural issues, which are likely to continue into adult life.

Recent reports that child poverty figures in the UK are continuing to rise, despite successive Governments’ promises to reduce them, does not bode well in this context. Indeed, it would seem to indicate that it will be some time before the yawning gaps in inequality that we see at primary school and their knock-on effects on children’s wellbeing in adolescence can be closed.

Longitudinal Latent Cognitive Profiles and Psychosocial Well-being in Early Adolescence is research by Afshin Zilanawala, Amanda Sacker and Yvonne Kelly and is published in the Journal of Adolescent Health

Photo credit: Creative curriculum  US.Army

 

Why mental health is not your average problem

There have been numerous reports in recent months of a growing crisis in children and young people’s mental health. From increased suicide attempts and incidents of self-harm to reports of a complete lack of appropriate services, it’s said that young people are facing unprecedented social pressures and that society’s response has been inadequate. When it comes to trends over time in the mental wellbeing of young people, the evidence to date is conflicting. Meanwhile, new research by Andy Ross and colleagues at the ESRC International Centre for Lifecourse Studies at UCL shows that the way we look at those trends may be masking an important story that could help those trying to tackle the problem to identify those most at risk of serious mental health problems.

There are few more high profile health issues at the moment than the mental health crisis among young people. The younger Royals may have helped raise public awareness about the need for more open conversations, but they agree the job is far from done. From a policy perspective, there are pledges of mental health legislation reform in the Queen’s Speech promises from Teresa May that her Government will “ensure that mental health is prioritised in the NHS in England”. But a recent report from NHS Providers says the government’s commitment to parity of esteem between mental and physical health services is being undermined by a failure to ensure funding increases reach the frontline.

Having a full and clear grasp of the scale of the problem and how young people’s mental wellbeing is changing over time will be key to any policies that may be developed to tackle it.

One of the main problems facing those trying to better understand the extent of the problem and whether the situation is getting better or worse, is that the evidence presented to date has been somewhat conflicting and, in some cases, doesn’t give the whole picture.

Some research has shown young people’s mental health deteriorating in the nineties and then stabilising and slightly improving in the early 2000s, whilst other work has evidenced a steady decline. Findings have also been different depending on whether it is teachers, parents or the young person themselves who are asked to report the symptoms.

Trends over time

We wanted to see whether we could add to and improve on the available evidence and show a more nuanced picture of mental health problems among young people by looking at trends over time, not just in respect of average levels of mental health, but also across the spectrum in levels of mental health. In simple terms, we were looking to see whether there were increases in the number of young people with unusually low levels of mental distress at the same time as increases in the numbers of those with very high levels of distress over an 18-year period.

Making use of information collected between 1991-2008 from more than 6,000 young people who took part in the British Household Panel Survey, we looked closely at their self-reported psychological distress. Once a year, young people between the ages of 16-24, were asked whether and how often, for example, they had experienced the loss of sleep through worry, a loss of confidence, felt constantly under strain, unhappy or depressed. They were also asked about positive symptoms such as their ability to concentrate and face up to their problems.

All this information was then combined to create an overall psychological distress score on a scale of 0-36, with high scores indicating high levels of psychological distress.

When we looked at the average psychological distress scores for young women in the study, we saw a small but significant increase over the 18-year period, indicating that, for this group, the situation worsened – in other words, their mental health deteriorated.

No increase was detected in the average scores for young men, which could be interpreted as a sign that levels of mental health among this group remained fairly stable.

At every time point, scores for women were worse than they were for men and this gap increased over time.

A story of polarisation

When we drilled deeper into the scores, however, the story changed a little. For young women there was a very clear and consistent increase in high and very high scores, following the overall increase in average scores mentioned above. The prevalence of those with high scores (17 and higher) increased from 12.8 per cent in 1991 to 18.8 per cent in 2008, and the prevalence of those with very high scores (20 and higher) from 6.6 per cent to 11.9 per cent. At the same time, however, there was also a small increase in the prevalence of those with scores much lower than average (5 and lower) from 10.6 per cent to 13.0 per cent.

It seems that when we move beyond looking only at average mental health scores over time, we identify two very different yet concurrent pictures of young women’s mental health. An increase in the number of young women presenting very poor levels of psychological distress, whilst at the same time an increase in young women with far better levels of mental health than average. In other words, over time, the mental wellbeing of young women appears to have become polarised.

Previously, our findings suggested that levels of mental health among young men had remained stable. However, when we look at both low and high scores over time, we find a very clear and consistent increase in low and very low scores, suggesting an overall improvement in levels of mental health among young men.

The prevalence of those with low and very low scores increased from 8.1 per cent to 15.6 per cent and from 2.1 per cent to 5.9 per cent respectively. At the other end of the scale however, whilst there was an increase in prevalence of those with high and very high scores, this increase was too small for us to consider it statistically significant[1]. Nevertheless, by considering trends at both ends of the spectrum we identified an improvement in young men’s mental health, which was otherwise ‘hidden’ when we only looked at average scores over time.

Although our study did not delve deeply into the backgrounds and circumstances of the young people with low and high scores, we did look at income levels to see if increasing levels of inequality might explain what we were seeing. It doesn’t appear to.

What we did find was evidence to support earlier research, which suggests that girls might feel increased pressure to achieve academically, which could contribute to increased levels of psychological distress.

Doing it for themselves

We are yet to explore causes for these trends, however one area that remains significantly under researched is the idea that we are becoming a more individualistic society, in which there are increased expectations placed on young people and an emphasis on them “doing it for themselves”. This includes increased pressure to take responsibility not just for one’s successes, but also for one’s failures, previously thought of as misfortunes, such as unemployment, illness and addiction. It is easy to imagine how the personalising of one’s failings could contribute to a young person’s poor mental health, or how they might develop a fear of failure even.

On the other hand, taking more responsibility for their own destiny could be empowering when things go well, boosting their self-esteem and confidence.

Evidence of polarising trends in young women’s mental health could be the first step in linking time trends to the sort of cultural and societal individualization that is being increasingly talked about amongst those concerned with the health and wellbeing of the UK’s young people.

For young women, continuing gender inequalities (some legislative, some cultural), which serve to frustrate women’s dreams of self-realisation, might also help to explain the differences in poor levels of mental health in particular that we see between them and young men.

By 2020, the NHS has promised that 70,000 more young people will be able to access services for their mental health problems. Robust evidence on trends and how the story of young people’s mental health is changing over time will be key to ensuring those services are provided effectively and efficiently.

Time trends in mental well-being: the polarisation of young people’s psychological distress is research by Andy Ross, Amanda Sacker and Yvonne Kelly and is published in the Journal of Social Psychiatry and Psychiatric Epidemiology

Photo credit: Allan Bergman

A risky problem: what can keep young people away from alcohol and cigarettes?

Smoking and drinking among very young people has been declining in recent years, but it’s not all good news. There is still a lot of public health concern around the numbers of older children who are consuming alcohol and cigarettes, as these are the young people most likely to come to harm as a result of drinking too much. Their risky behaviours are also likely to persist and intensify into adulthood. So what factors might prevent a young person from smoking and drinking in the first place? New research published in BMC Public Health shows that levels of happiness among children and awareness of the risks may be key to success. Lead author on the research, Noriko Cable, explains more. 

According to Public Health England (PHE), alcohol is now the leading risk factor for ill-health, early mortality and disability among those aged 15 to 49 in England. It wants to “prevent and reduce” the harms caused by alcohol. It also has ambitions to create “a tobacco-free generation” by 2025.

The most recent figures from the Survey of Smoking, Drinking and Drug Use Among Young People in England show that around 90,000 children aged between 11 and 15 are regular smokers and 240,000 have drunk alcohol in the past week. These figures are the lowest they have been since the survey began in 1982.

However, recent research published in BMC Public Health by colleagues at UCL, shows that around one in seven 11 year-olds is drinking alcohol and that having peers who consume alcohol makes them four times more likely to drink that their peers who don’t. We also know that smokers start young, two thirds of them before the age of 18.

So we wanted to examine more closely the sorts of things that might drive young people away from cigarettes and alcohol. In this way we hope to arm policy makers, health practitioners and those working directly with or caring for children and young people with information that can help with the development of clear policies and interventions.

Protective role

We focused on three factors thought to play a protective role in preventing young people from starting to smoke and drink. These were: their awareness of the harms, their well-being or happiness and how supportive their networks of friends and family were.

Information came from Understanding Society, a large UK survey, which, in addition to collecting a wide range of social and economic information from everyone in the household aged 16 and over, has a special self-completion questionnaire for 10-15 year olds. Our sample contained 1,729 boys and girls.

We examined answers at two time points (approximately a year apart) to questions about their smoking and drinking. With these two sets of information, we were able to see whether they had started but then stopped smoking or drinking, whether they were persistent users of cigarettes and alcohol, whether they had started between the first and second surveys (initiation) or whether they had not smoked or drunk alcohol at either point.

The children were also asked about how happy they were with different aspects of their lives, including how they were getting on at school, how they felt about their appearance, family and friends and life in general.

On a scale of 1-4, the children were asked to rate how risky they thought different levels of smoking and drinking were. They were also asked how many supportive friends they had; friends they could confide in.

Harm awareness and happiness

Nearly 70 per cent of the study participants described themselves as persistent non-users of alcohol and cigarettes, and around 13 per cent categorized themselves as persistent users. Persistent non-users scored highest on harm awareness and happiness tests compared to the other groups.

About 8 per cent of the study group labelled themselves as ex-users and about 13 per cent had started using alcohol or cigarettes between the first and second time they completed the survey. Young people aged 10 to 12 were more likely to be in the persistent non-use group, whereas participants aged 13 and above were more likely to be in the persistent user and initiation groups.

We were surprised that while, for most young people, knowledge of the potential and actual harms of alcohol and smoking was linked with them never drinking or smoking, for some it seemed to be associated with them starting to drink or smoke. It is possible that positive expectations from drinking alcohol or smoking cigarettes may, in some way, have overridden their awareness of what harm they could do.

The happier the young person was, and more aware of the harms of alcohol and cigarettes, the more likely they were never to drink or smoke. Having supportive friends to confide in did not play a role in preventing adolescents from using alcohol or cigarettes.

Promoting happiness and harms

So it seems that promoting young people’s happiness and well-being and making them aware of the harms of smoking and drinking may be key to keeping them away from alcohol and cigarettes. In terms of possible timings for information and interventions, another takeaway from the study might be that working with children between the ages of 10 and 12, before they start trying cigarettes and alcohol, could be important.

Because the information used in this study is self-reported, we need to interpret the findings with caution, but they do suggest that making adolescents aware of alcohol and smoking related harm can be helpful in preventing them from engaging in risky health behaviors.

Colleagues at the Centre are now getting to grips with the new age 14 data from the Millennium Cohort Study and, in collaboration with Mentor, a charity working on the ground in schools to tackle alcohol and drug abuse, are hoping to develop our growing body of evidence in this area that will help formulate policies and activities to make some of Public Health England’s ambitions around smoking and alcohol a reality.

Further information

What could keep young people away from alcohol and cigarettes? Findings from the UK Household Longitudinal Study is research by Noriko Cable, Maria Francisca Roman Mella and Yvonne Kelly and is published in BMC Public Health.

 

Cyberbullying – the long term effects

For all the wonderful opportunities and connectivity that the internet has brought in recent decades, it seems likely that 2016 will be the year that the internet is mostly remembered for trolling and cyberbullying. It’s a growing phenomenon, not least among school-aged children. In 2015/16 the children’s charity Childline reported a 2 year increase of 88 per cent in calls from children about cyberbullying and the Government recently funded an app aimed at helping pupils report incidents. Meanwhile, a team of researchers at Queen Mary University of London has been looking for the first time at how cyberbullying affects the mental health of young people later on in their lives. Dr Amanda Fahy explains more.

There are three Ps which distinguish cyberbullying from what we might think of as more ‘traditional’ face-to-face forms of bullying: permanence, publicity and permeability.

The thinking behind our study was that all these factors may well mean that the mental wounds and scars inflicted on young people who experience this type of bullying, run even deeper. Certainly it has been identified in numerous quarters as a matter of serious public health concern.

Whilst one or two international studies have demonstrated a link between being a cybervictim and signs of depression, there is little evidence in the UK to show who is affected and how over time. Our research looks at young people who are bullied, those doing the bullying and those who are both bullying and being bullied and goes onto examine their mental health one year down the line.

Regeneration study

The research made use of information collected initially from more than 3,000 Year 7 (aged 11-12) students who participated in the Olympic Regeneration in East London (ORiEL) study which was designed to evaluate the impact of the urban regeneration associated with the London 2012 Olympic Games.

When the students in the study moved into Year 8 (Aged 12-13) they were asked some questions about their experiences of cyberbullying in the preceding 12 months. These included how often they had received rude or nasty comments from someone, become the target of rumours spread online or received threatening or aggressive comments.

The same students were asked if and how often they had been a perpetrator of cyberbullying. Had they sent rude or nasty comments to anyone, spread rumours or sent aggressive or threatening messages online?

A year later when the students had entered Year 9 (aged 13-14) students were asked a range of questions about their experiences and feelings from the previous two weeks and this information was used to create scores for signs of depression, social anxiety and poor mental well-being.

Involvement in cyberbullying

More than 40% of the students reported involvement in cyberbullying in the previous 12 months – 13.6% as cybervictims, 8.2% as cyberbullies and 20.4% as cyberbully-victims. Girls were a lot less likely than boys to fall into the latter category.

Around a quarter of all the young people interviewed showed signs of depression and/or social anxiety and here, with girls more likely than boys to report these symptoms and have lower levels of well-being.

Victims of cyberbullying were almost twice as likely as the completely uninvolved youngsters to show signs of depression even after taking a range of background factors into account. The effect stayed strong even after we accounted for them having poor mental health when they joined the study age 11-12.

Those who reported both being bullied and doing the bullying were more than twice as likely as those who were completely uninvolved to be depressed, whilst those who said they had only been involved in bullying were no more or less depressed than their uninvolved peers.

Damaging effects

The findings for social anxiety and lower levels of well-being were similar to the findings for depression, providing us with a clear picture of the damaging psychological impacts of cyberbullying for victims and for those who were both bullied and perpetrators themselves of cyber bullying.

With 4 out of ten children of this age involved in some way with cyberbullying and given that our results showed that even low level experiences of cyberbullying can have harmful effects over time, it is key that all those involved in the care, education and well-being young adolescents have a grasp of the issues involved and the tools to reduce and prevent its occurrence where possible. Our research indicates that boys and young people who are both victims and bullies are important groups to target.

Longitudinal Associations Between Cyberbullying Involvement and Adolescent Mental Health is research by Amanda Fahy, Stephen Stannsfeld, Melanie Smuk, Neil Smith, Steven Cummins and Charlotte Clark. It is published in the Journal of Adolescent Health.

Photo credit: bad-cyberbully, Winning Information

Giving children the best possible start – what matters most?

Child of our Time Editor Yvonne Kelly spoke to a 500-strong audience of politicians and professionals in Gothenburg recently on what matters when it comes to giving children the best possible start in life.

Yvonne was the keynote speaker at the conference hoping to identify the best strategies for making Gothenburg a more equal and socially sustainable city.

Yvonne, Professor of Lifecourse Epidemiology at the ESRC International Centre for Lifecourse Studies at UCL  explained which factors are most closely linked with a child’s health and well-being and presented her research findings on children’s verbal skills, behaviour, bedtimes, reading and obesity.

Sugar-coating the childhood obesity problem

Child obesity figures appear to be on the rise again, causing much concern after earlier signs they had levelled off.  The proportion of  10- and 11-year-olds who were obese in 2015-16 was 19.8 percent, up 0.7 percent on the year before. There was a rise of 0.2 percent among four- and five-year-olds. The announcement comes as researchers at the ESRC International Centre for Lifecourse Studies at UCL have been looking in detail at how and when children become overweight. The team has also been asking whether children who are overweight are more likely to go on to smoke and drink alcohol and if their mental health suffers as they become adolescents. Yvonne Kelly explains the research findings, and considers their implications for the Government’s recent strategy for tackling the childhood obesity epidemic.

The Government’s much-awaited and much-debated childhood obesity strategy was published in August. In the end, it was less comprehensive than had been anticipated, less draconian too. It focuses on two things – reducing sugar consumption and increasing physical activity. But will it be effective in reversing this worrying obesity trend among our children?

It’s fair to say we don’t fully understand what things influence whether, when and why a child might become overweight. Research to date has shown three distinct weight pathways for children: a healthy BMI throughout childhood; becoming overweight during childhood and being overweight/obese throughout childhood.

Previous research has also shown that the child’s mother’s weight, smoking in pregnancy, mental health and other social and economic factors have some link to childhood obesity. But the evidence is far from complete and, where a child’s own mental health is concerned, it’s not at all clear which way the association works.

To try to get a clearer picture of all these things, our research looked at the BMI paths of the participants in the Millennium Cohort Study, which has tracked the lives of nearly 20,000 children born between 2000-2002. We used data collected at birth, 9 months, age 3, 5, 7 and 11.

Once we had established who was on which BMI path, we were able to look at what factors were at play in their lives and to see whether a tendency to overweight and obesity was an indication that a child would go on to face mental health difficulties in early adolescence or start smoking and drinking.

Four pathways to obesity

The BMI data for the 17,000 children we were able to look at for our study showed four distinct groups of children. More than 80 per cent of them stayed on an average non-overweight path throughout their childhood – we call it the ‘stable’ path. There was a small group (0.6 percent) of children who were obese at age 3 but were then in the stable group by age 7. We call them the the ‘decreasing’ group. There was a ‘moderate increasing group’ (13.1 percent) where children were not overweight at age 3 but whose BMIs increased throughout childhood into the overweight (but not obese) range. Finally we had a ‘high increasing’ group of children (2.5 percent) who were obese at age 3 and whose BMIs continued to increase.

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Girls were 30 percent more likely to be in the ‘moderate increasing’ group than boys and were half as likely to be on the ‘decreasing’ path. Indian, Pakistani and Black African children were up to two times more likely to be on the ‘moderate increasing’ path whilst Pakistani, Black Caribbean and Black African children were up to three times more likely to belong to the ‘high increasing’ group.

The wealthiest children were least likely to be in the ‘moderate increasing’ BMI group and children of mums who smoked during pregnancy were up to two times as likely to belong to increasing BMI groups. Children with overweight mums were most likely to be on the moderate and high increasing paths.

Children on the moderate and high increasing paths were less likely to have regular family routines – they were more likely to skip breakfast or have non-regular bedtime schedules. Interestingly, however, no strong links emerged with some of the things more readily linked with childhood obesity such as sugary drinks and snacks, watching TV and lack of physical activity such as sports, the main focus of the newly published childhood obesity strategy.

Overweight factors

So it seems quite a large range of factors influence the likelihood of a child becoming overweight or obese over the first decade of their life. On top of this, being overweight or obese would also seem to point to a less happy and fulfilling early adolescence and a tendency to explore risky behaviours like smoking and drinking.

Although our research did not show a clear link with sugary drinks and snacks, there are nevertheless some compelling arguments for reducing the sugar intake of our children. These are not only related to problems of obesity, but to wider issues including the major issue of tooth decay and associated emergency hospital admissions. There is also increasing evidence of the ‘addictive’ nature of sugar with research suggesting that it stimulates a sort of ‘reward path’ in certain centres of the brain meaning that the more we have the more we want. It has been shown that people who reduce their sugar intake tend to crave it less.

Where sugar taxes have been introduced in other countries (Mexico, France, Denmark, South Africa amongst others), the intervention has been shown to help reduce the consumption of sugary drinks. As yet, there is no evidence that it helps reduce BMI and tackle obesity, but it’s argued it will take time for us to see an effect on whole populations.

Disadvantaged families

It is hard to predict how much impact the voluntary rather than mandatory reduction in sugar content of drinks and snacks agreed in the strategy will have. As for the sugar tax that will be introduced in two years’ time, there remain concerns that disadvantaged families more likely to purchase and consume sugary goods than their better off counterparts will be hardest hit. Policy makers will need to think hard about how any negative consequences of this might be counteracted.

Our research shows clearly that when it comes to the likelihood of a child becoming overweight or obese in the first decade of their life, there are many more influences than just sugar. Those influences are at play in families even before our children are born.

Helping pregnant women to stop smoking and maintain a healthy weight, making sure all young children have healthy eating and sleeping routines would seem to be key, together with targeted support for the ethnic and social groups identified as being most at risk.

Further information and resources

BMI development and early adolescent psychosocial well-being: UK Millennium Cohort Study is research by Yvonne Kelly, Praveetha Patalay, Scott Montgomery, and Amanda Sacker. The work, published in Pediatrics, is funded by the Economic and Social Research Council.

Media coverage

Photo credit: Kim Stromstad