Mental health and well-being in
children and young people in the EU
Prof. Ulrike Ravens-Sieberer
University of Hamburg, Germany
Prof. Dr. Ulrike Ravens-Sieberer, MPH
Head of Research – Professor for Child
Public Health
University Medical Center HamburgEppendorf
Center for Obstetrics and Pediatrics,
Department of Psychosomatics in
Children and Adolescents
Martinistr. 52
D-20246 Hamburg
EC Thematic Conference on Mental Health in Youth and
Education “Promotion of Mental Health and Well-being of
Children and Young People- Making it Happen”,
[email protected]
www.child-public-health.de
Stockholm,
29-30th
September
2009
Mental Health in Youth and Education
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
Background
WHO declared „Child mental health is a key area of concern“
(2003, 2005)
ƒ Childhood health and illness has changed considerably over
the past century and had lead to a higher importance of mental
health problems and of socioeconomic influences on health –
“New Morbidity”(Palfrey et al. 2005)
ƒ WHO states, that the „development of a child and adolescent
mental health policy requires an understanding of well-being
and the prevalence of mental health problems among children
and adolescents“(2006)
ƒ However, quantifying well-being and the burden of mental
disorders in children and adolescents in Europe is a difficult
task.
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
Mental Health in Youth and Education
Results on mental well-being in children
from 3 recent European studies
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
Mental Health in Youth and Education
M41.
HBSC findings:
percentages of European
girls and boys reporting
high life satisfaction (LS)
(n > 160.000)
Here is a picture of a ladder.
The top of the ladder ‘10’ is the best possible life for you and the bottom ‘0’ is the worst possible life for you.
In general, where on the ladder do you feel you stand at the moment?
Tick the box next to the number that best describes where you stand.
100
80
60
‰
10
‰
9
‰
8
‰
7
‰
6
‰
5
‰
4
‰
3
‰
2
‰
1
‰
0
boys
girls
Best possible life
Worst possible life
Source: Cantril, H. (1965). The pattern of human concern. Rutgers University Press.
Adapted for HBSC survey 2001/02, 2005/06
40
20
... girls are less likely to
experience high lifesatisfaction than boys
0
Normal LS
29-30th September 2009
Low LS
Prof. Dr. Ravens-Sieberer
Stockholm
Mental Health in Youth and Education
boys
15 year olds with
high life satisfaction
girls
29-30th September 2009
... girls are less likely to
expereince high lifesatisfaction than boys in
almost every country
Prof. Dr. Ravens-Sieberer
Stockholm
Mental Health in Youth and Education
The KIDSCREEN Index:
a cross-cultural indicator of mental well-being and quality of life
ƒ
Fifth EC Research Framework Programme; area Public Health
(European Commission's grant number QLG-CT-2000-00751)
ƒ
European project to develop a standardised cross-cultural generic
tool to assess mental well-being / quality of life in children and
adolescents
During the past week …
1.
Have you felt fit and well?
2.
Have you felt full of energy?
3.
Have you felt sad?
4.
Have you felt lonely?
5.
Have your had enough time for yourself?
6.
Have you been able to do the things that you want
to do in your free time?
7.
Have your parent(s) treated you fairly?
8.
Have you had fun with your friends?
9.
Have you got on well at school?
10. Have you been able to pay attention?
Ravens-Sieberer et al. (2006) Pabst Science Publisher
Erhart et al. (2009) International Journal of Public Health
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
Mental Health in Youth and Education
European KIDSCREEN-Study:
Average scores in mental well-being items
12-18 year old girls and boys
Have you had fun?
Have you felt
cheerful?
Have you been in a
good mood?
girls
boys
Have you felt satisfied
with your life?
Have you felt pleased
that you are alive?
Has your life been
enjoyable?
1
29-30th September 2009
2
Prof. Dr. Ravens-Sieberer
3
Stockholm
4
on average children
and adolescents in
Europe would give a
positive response
when asked about
their mental well-being
5
Mental Health in Youth and Education
European KIDSCREEN-Study:
However a noticeable percentage of respondents report poor
mental well-being – this figure varies across countries …
%
0
-5
-10
-15
-20
-25
-30
... between 4% to 29% of
children and adolescents in
European countries report
noticeable low mental wellbeing
Netherlands
Germany
Czech Republic
Hungaria
29-30th September 2009
Switzerland
Sweden
UK
Greece
Prof. Dr. Ravens-Sieberer
Stockholm
Austria
Espania
France
Poland
Mental Health in Youth and Education
KIDSCREEN-10-Index- mean score (children)
European KIDSCREEN-Study: Age differences mental well-being decreases with age, and
gender differences in mental well-being increase with age
53
... the average level of
positive mental health and
well-being shows a
decrease while the
respondents grow older –
but especially in girls
***
51
***
49
***
47
11 year olds
13 year olds
45
15 year olds
43
41
39
boys
29-30th September 2009
Prof. Dr. Ravens-Sieberer
girls
Stockholm
Mental Health in Youth and Education
European KIDSCREEN-Study:
Gender differences - a larger proportion of girls than boys
report noticeable low mental well-being
Turkey
Russian Federation
Greenland
Romania
Bulgaria
Slovenia
Luxembourg
Austria
Spain
Germany
United Kingdom
Macedonia
Belgium
Portugal
Switzerland
Girls
Boys
0
29-30th September 2009
10
Prof. Dr. Ravens-Sieberer
20
30
Stockholm
... the proportion of girls
with low mental well-being
exceeds that of boys in
almost every European
country.
The girls to boys ratio
40
501.1 to 2.3
ranges from
Mental Health in Youth and Education
European KIDSCREEN-Study:
Ressource Social Support (Oslo Social Support Scale, OSSS):
Mean KIDSCREEN-52-Psychological Well-being
An association between the OSSS and KIDSCREEN-52 Psychological
Well-being in all countries is apparent. High OSSS => high mental.WB
60
55
... strong social support is
significantly associated
with higher mental wellbeing
Austria
Espania
Netherlands
Switzerland
Germany
Ireland
Greek
50
Czech Republic
UK
Hungaria
45
France
Poland
40
Social
Support ...
poor
29-30th September 2009
moderate
Prof. Dr. Ravens-Sieberer
strong
Stockholm
Mental Health in Youth and Education
KIDSCREEN-10-Index- mean score (children)
European KIDSCREEN-Study: Socioeconimic differences
- A statistically significant association between familial
affluence and positive mental health for all countries is apparent …
53
... high familial affluence is
significantly associated
with higher mental wellbeing
Austria
Belgium
51
Bulgaria
Germany
49
Greenlan
Luvembourgh
47
Portugal
Romania
45
Russian Federation
Slovenia
43
Spain
41
Turkey
Switzerland
Macedonia
United Kingdom
39
FAS low
29-30th September 2009
FAS medium
Prof. Dr. Ravens-Sieberer
FAS high
Stockholm
***
All differences
significant at
p<.001 except
Greenland
Mental Health in Youth and Education
Macro-dimension: mental health data and
socioeconomic data
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
Mental Health in Youth and Education
Flash EUROBAROMETER Series #246
Parents’ views on the mental health of
their child
Conducted by The Gallup Organization, Hungary
upon the request of EU Directorate General Health and
Consumers
ƒ Flash Eurobarometer (No 246) measures parents’ views on
the mental health and QoL of their child using the KIDSCREEN
10 index.
ƒ Fieldwork was carried out 2008
ƒ N=12,750 randomly selected parents of 6 -17 year-old children
were interviewed in the 27 EU Member States.
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
Mental Health in Youth and Education
National wealth and adolescents‘ mental well-being
Association between QoL/MH index mean scores (Proxy) and GDP
(Purchasing Power Parity) per capita
KIDSCREEN-10 Country Mean Score
(R=0.49; R2=0.24; p<.01)
90
... young people from
wealthy countries are more
likely to experience high
85
levels of mental well-being
Lithuania, Latvia,
Poland, Romania,
80
Lo
Slovakia, Estonia
lo w
w
P
GD
h
H
hi g h M
g
hi
G
MH DP
75
Luxembourg,
Netherlands,
Austria, Sweden,
Belgium
70
65
10
20
30
40
50
Gross Domestic Product - PPP per capita in thousand Euros
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
Austria
Belgium
Bulgaria
Cyprus
Czech Rep.
Denm ark
Estonia
Finland
France
Germ any
Greece
Hungary
Ireland
Italy
Latvia
Lithuania
Luxem bourg
Malta
Netherlands
Poland
Portugal
Rom ania
Slovakia
Slovenia
Spain
Sw eden
United Kingdom
Mental Health in Youth and Education
National wealth and adolescents‘ mental well-being
KIDSCREEN-10 Country Mean Score
Association between QoL/MH index mean scores (Proxy) and
youth unemployment rate
... higher levels of youth
(R=0.41; R2=0.17; p<.01)
unemployment rates are
Fe
w
associated with lower
hi 90
gh Un
R
MH
mental health
Austria, Netherlands,
Ireland, Germany, UK
85
Latvia, Lithunia,
Estland, France
80
75
R
Un
h
hi g M H
low
70
65
5
10
15
20
25
30
Youth unemplyoment rate
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
35
40
45
Austria
Belgium
Bulgaria
Cyprus
Czech Rep.
Denm ark
Estonia
Finland
France
Germ any
Greece
Hungary
Ireland
Italy
Latvia
Lithuania
Luxem bourg
Malta
Netherlands
Poland
Portugal
Rom ania
Slovakia
Slovenia
Spain
Sw eden
United Kingdom
Mental Health in Youth and Education
National wealth and adolescents‘ mental well-being
Association between QoL/MH index mean scores (Proxy) and annual
expenditure on public and private educational institutions per
pupil/student in EUR PPS (R=0.46; R2=0.21; p<.01)
KIDSCREEN-10 Country Mean Score
90
Austria, Netherlands, Belgium,
... higher annual Germany, Ireland, UK
hig
expenditures on education
h
hig exp
hM .
are associated with higher
H
levels of mental well-being
85
80
75
70
low e
x
low M p.
H
65
5
10
15
Poland, Latvia,
Lithunia, Slovakia
20
25
annual expenditure on public and private educational
institutions per pupil/student
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
30
Austria
Belgium
Bulgaria
Cyprus
Czech Rep.
Denm ark
Estonia
Finland
France
Germ any
Greece
Hungary
Ireland
Italy
Latvia
Lithuania
Luxem bourg
Malta
Netherlands
Poland
Portugal
Rom ania
Slovakia
Slovenia
Spain
Sw eden
United Kingdom
Mental Health in Youth and Education
Summary
ƒ Different dimensions of inequalities in mental well-being are
apparent for young people including gender, age, geography
and affluence/SES.
ƒ Many aspects of young people’s mental health / well-being are
also affected by national wealth
ƒ A European indicator for monitoring child well-being is
available. The analyses of the KIDSCREEN data shows the
advantages and possibilities of comparable European survey
data.
Implications
ƒ The evidence on mental health inequalities among young
people has implications for policy development at national and
international levels
ƒ Programs devised to improve young people’s health need to
take into the existing inequalities and avoid making the gaps
wider
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
Mental Health in Youth and Education
Thank you!
[email protected]
www.child-public-health.de
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
Mental Health in Youth and Education
References:
ƒ
ƒ
ƒ
ƒ
Erhart, M., Ottova, V., Gaspar, T., Nickel, J., Ravens-Sieberer, U., the
HBSC Positive Health Focus Group (2009). Measuring mental health
and well-being of school-children in 15 European countries: Results
from the KIDSCREEN-10 Index. International Journal of Public Health
54: doi 10.1007/s00038-009-5407-7
Ravens-Sieberer, U., Ottova, V., Torsheim, T., Hetland, J., Nickel, J.,
Vollebergh, W., Cavallo, F., Jericek, H., Alikasifoglu, M., Välimaa, R.,
Erhart, M. & the HBSC Positive Health Focus Group (2009).
Subjective health, symptom load and quality of life of children and
adolescents in Europe. International Journal of Public Health 54: doi
10.1007/s00038-009-5406-8.
Ravens-Sieberer, U., Wille, N., Erhart, M., Nickel, J., Richter, M.,
Suhrcke, M. (2008). Socioeconomic Inequalities in mental health
among adolescents in Europe. In: Social cohesion for mental wellbeeing among adolescents (S. 26-42). Kopenhagen: WHO Regional
Office for Europe.
Ravens-Sieberer et al., (2006). The KIDSCREEN questionnaires.
Quality of life questionnaires for children and adolescents –
handbook. Lengerich: Papst Science Publisher.
29-30th September 2009
Prof. Dr. Ravens-Sieberer
Stockholm
Mental Health in Youth and Education
This paper was produced for a meeting organized by Health & Consumers DG and represents the views of its author on the
subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of
the Commission's or Health & Consumers DG's views. The European Commission does not guarantee the accuracy of the data
included in this paper, nor does it accept responsibility for any use made thereof.