Guernsey Emotional
Wellbeing Survey 2010
A Cross-Sectional Survey of Mental Wellbeing
and Common Mental Health Disorders in
Guernsey and Alderney
Dr Sara Johnson
Clinical Psychologist, Service Manager & Clinical Lead
Primary Care Mental Health & Wellbeing Service
Jenny Cataroche
Public Health Analyst/Epidemiologist
Tessa Hinshaw
Research Assistant
Dr Stephen Bridgman
Director of Public Health
A publication of the Public Health and Strategy Directorate, Health and Social
Services Department, States of Guernsey.
ISBN 1-899905-00-6
i
Acknowledgements
The authors would like to thank all those who have contributed to the GEWS, in
particular Emily Litten at Mind and the Mental Health Service User Group for
consultation and advice on the content and design of the questionnaire, Ed Ashton at
the Social Security Department and Helen Walton at the Policy Council and Amy
Tostevin, Laura Mitchell and Taryn Hutchinson for their assistance in the distribution of
the questionnaire.
ii
Glossary
ANOVA
Analysis of Variance A statistical test used to determine whether
or not the means of more than two groups are significantly
different.
GHQ/GHQ-12
General Health Questionnaire A 12-question screening tool
widely used in the Primary Care setting to measure psychological
wellbeing.
HADS
Hospital Anxiety and Depression Scale
HASCAS
Health And Social Care Advisory Service An independent
consultancy service appointed to undertake an external review of
the HSSD’s Adult Mental Health Service in 2008.
HSSD
Health and Social Services Department
SSP
States Strategic Plan
WEMWBS
Warwick-Edinburgh Mental Wellbeing Scale
WHO
World Health Organisation
iii
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iv
Table of Contents
1.0
Executive Summary ......................................................................................... 1
2.0
Introduction and Background ........................................................................ 2
2.1 Introduction ........................................................................................................................... 2
2.2 Background .......................................................................................................................... 2
2.3 Local Context ....................................................................................................................... 3
2.4 Aims ...................................................................................................................................... 3
3.0
Methodology..................................................................................................... 4
3.1 Design ................................................................................................................................... 4
3.2 Sample .................................................................................................................................. 4
3.2 Measures .............................................................................................................................. 4
3.3 Ethical Approval ................................................................................................................... 6
3.4 Weighting .............................................................................................................................. 6
4.0
Results .............................................................................................................. 7
4.1 Respondent Characteristics ................................................................................................ 7
4.2 Self-Perceived Health .......................................................................................................... 8
4.3 Emotional Wellbeing: The Warwick-Edinburgh Mental Wellbeing Scale ........................ 9
4.4 Experience of Symptoms of Common Mental Health Disorders: The Hospital Anxiety
and Depression Scale (HADS) ......................................................................................... 10
4.5 Mental Ill-health and Mental Wellbeing ............................................................................ 11
4.6 Views and Preferences regarding Adult Mental Health Services .................................. 12
4.7 Qualitative Data .................................................................................................................. 12
5.0
Summary and Conclusions ........................................................................... 14
6.0
Limitations ...................................................................................................... 15
7.0
References...................................................................................................... 16
8.0
Appendices..................................................................................................... 18
v
1.
Executive Summary
•
•
•
•
•
•
•
•
•
•
The Guernsey Emotional Wellbeing Survey (GEWS) was undertaken in 2010
in response to a growing need to understand more about the mental and
emotional wellbeing and mental health of the people of Guernsey and
Alderney and to aid planning and development of Adult Mental Health
Services.
The GEWS was the first research aimed at measuring mental wellbeing and
the prevalence of the experience of symptoms of two common mental health
disorders, anxiety and depression, in Guernsey and Alderney. The survey
also presented a unique opportunity to poll respondents’ views and
preferences on how mental health services should be developed.
It consisted of a cross-sectional postal survey which was mailed out to a
quasi-randomised sample of 5% of the Guernsey and Alderney adult
population.
Two validated measures were used: the Warwick Edinburgh Mental
Wellbeing Scale (WEMWBS) and the Hospital Anxiety and Depression Scale
(HADS). In addition a service-related questionnaire allowed for open
comment by respondents.
722 completed surveys were returned (a 26% return rate).
Results revealed a mean WEMWBS score of 50.53 and a distribution of
wellbeing scores that saw 16% of respondents classified as having low
mental wellbeing, 67% as having moderate wellbeing and 17% as having
high wellbeing. These findings were similar to those found in similar UKbased studies.
The proportion of respondents whose HADS scores put them above the
clinical cut-offs for anxiety and or depression was 21%, or one in five, which
is slightly higher relative to recent estimates for Jersey (15%) and the UK
(18%).
Increased likelihood of low mental wellbeing and anxiety/depression
symptomatology was found for those who were young, with low incomes and
those who were unemployed.
26% of those with low mental wellbeing were not anxious or depressed,
supporting the notion that mental wellbeing is not simply the absence of
mental ill-health.
The GEWS findings support the development of early intervention mental
health services, aimed not only at reducing the prevalence of the experience
of mental ill-health but also at improving the mental well-being of the
population as a whole.
1
2.0
Introduction and Background
2.1
Introduction
The Guernsey Emotional Wellbeing Survey was undertaken in 2010 in response to a
growing need to understand more about the mental and emotional wellbeing and
health of the people of Guernsey and Alderney.
The States Strategic Plan (SSP) states that the purpose of the States of Guernsey is
to promote the wellbeing of the Island of Guernsey (2009, Billet d’État XXVI).
Experiencing ‘good mental health’ is a key part of this wellbeing. The World Health
Organisation (WHO 2001) defines mental health not solely as the absence of mental
health problems, but rather as
“A state of wellbeing in which the individual realises his or her own abilities, can cope
with the normal stresses of life, can work productively and fruitfully, and is able to
make a contribution to his or her community.”
In turn, psychological well-being can be seen as a combination of feeling good (happy,
content, interested, engaged, confident and showing affection for others) and being
able to function effectively (developing one’s potential, having some control over one’s
life, a sense of purpose, experiencing positive relationships) (Huppert 2009).
There is increasing evidence that positive mental wellbeing leads, on an individual
level, to a more flourishing school, work and home life and this, in turn, brings benefits
for the wider community as a whole. Improved psychological wellbeing is also
associated with physical health benefits (e.g. Danner, Snowden & Friesen 2001).
Furthermore, evidence suggests that action to improve mental wellbeing can have
very high economic and social returns (Foresight 2008). It has been suggested that
the best way to reduce the prevalence rate of mental health problems in the long-term
is to intervene at a population wellbeing level (Huppert 2005). It is therefore important
to collect data on levels of mental wellbeing in the community, in order to drive policy
planning, and to facilitate the evaluation of social policy initiatives.
2.2
Background
It is well-acknowledged that there has been a paucity of data relating to mental health
in Guernsey and Alderney (e.g. Bridgman 2010). The estimates that have been made
were based on the extrapolation to the Bailiwick of UK prevalence rates of mental
disorder, such as those of the Adult Psychiatric Morbidity Survey 2007 (Health &
Social Care Information Centre 2009) and were thus approximate at best. Although
the five-yearly Guernsey Healthy Lifestyle Survey includes generalised questions on
the experience of stress, it does not currently use any validated screening tools
relating to specific mental health disorders.
In Jersey, a 12-item version of the General Health Questionnaire (GHQ-12) has been
used in the Annual Social Survey and the results from the 2009 survey suggest that
the prevalence of common mental health disorders in that island is probably similar to
that in the UK (15% in the Jersey population versus 16% in the UK). Whilst it is
tempting to assume that prevalence rates in Guernsey and Alderney would be similar
to those in Jersey, and by extension the UK, there is of course no way of knowing
2
whether that assumption would be valid. The GHQ also has the limitation that it
cannot identify whether a disorder is depression, anxiety, or, as is often the case, a
mixture of both.
For these reasons a survey of mental wellbeing — the Guernsey Emotional Wellbeing
Survey (GEWS) — was designed and conducted locally. The GEWS was the first
attempt to measure mental wellbeing and the experience of common mental health
disorders (depression, anxiety and both together) for the populations of Guernsey and
Alderney.
2.3
Local Context
Following the recommendations made in the HASCAS report (2008) on the Adult
Mental Health Service, there has been significant service reconfiguration and
development in the Adult Mental Health service. One major development has been the
establishment of a Primary Care Mental Health & Wellbeing Service to enable access
to talking therapies via non-stigmatised settings, in the community and GP surgeries.
The survey took place against the backdrop of this development, therefore presenting
an ideal and unique opportunity to poll respondents’ views on the development of
Adult Mental Health services.
2.4
Aims of the Guernsey Emotional Well-being Survey 2010
1. To establish a baseline level of mental wellbeing in the populations of
Guernsey and Alderney.
2. To estimate the prevalence of mild to moderate anxiety and depression
disorders in Guernsey and Alderney.
3. To gain consultation from Bailiwick residents on how Primary Care services
should be developed.
3
3.0
Methodology
3.1
Design
Data collection in clinical psychological research is most commonly accomplished via
the administration of questionnaires or through the use of semi-structured interviews.
Questionnaires are usually self-report instruments, whereas interviews are
administered verbally by a researcher, either over the telephone or in person.
Although interview-based data collection is known to enhance participation rates,
thereby diminishing non-response and resultant selection bias, it is a method that is
highly resource intensive. Resource constraints precluded the use of interviews in the
GEWS; participants were recruited via a postal invitation wherein they were asked to
fill out and return a series of self-complete questionnaires. The postal design offered
a quick and relatively inexpensive way to obtain a snapshot of mental health and
wellbeing among the target group which it will be possible to refine and enhance, if
required, in future surveys.
3.2
Sample
The sample for the survey was 5% of the adult (defined here as aged 16 and over)
population of Guernsey and Alderney (n= 2761). The Social Security Department
database was used as the sampling frame as this is the most up to date register of
Guernsey and Alderney residents. Names were extracted on a semi-randomised
basis, with every tenth person aged 16 or over selected for the sample1. The survey
(appendix 2) was mailed out with an accompanying explanatory leaflet (appendix 1)
and a business postage paid reply envelope. A time limit of two weeks was given for
return of the survey. Postage costs were met by the Adult Mental Health service and
Psychology Department budgets. Data from completed and returned surveys were
entered onto an SPSS (Version 19) database and analysed by the Primary Care
Psychological Therapy Service Research Assistant.
3.3
Measures
The measures used were:
•
•
The 14-Item Warwick Edinburgh Mental Wellbeing Scale (WEMWBS; Tennant
et al 2007). A self-report scale which focuses entirely on positive aspects of
mental health, permitting an evaluation of low, moderate or high mental
wellbeing.
The Hospital Anxiety and Depression Scale (HADS; Snaith and Zigmond 1983).
A 14-item self-report scale designed to assess anxiety and depression
symptomatology.
Together these measures give an indication both of general mental wellbeing, positive
or negative (WEMWBS), and the number and proportion of surveyed individuals who
are symptomatic of either depression or anxiety (HADS).
1
Within the overall sample there was no pre-stratification by age or sex. An assumption was made that
the semi-randomised sampling frame would ensure an approximately equal number of participants of
each sex and age group were invited to participate in the study.
4
WEMWBS
Surveys in the UK routinely collect data on levels of mental wellbeing and in recent
years several of these surveys have adopted a tool specifically designed for this
purpose — the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS; Tennant et al
2007). WEMWBS is a short and psychometrically robust scale, available in full (14item) and short (7-item) versions, which has been demonstrated to have good validity
in UK subjects aged 16 and above. WEMWBS uses a 5-point Likert scale, with
responses ranging from ‘none of the time’ through to ‘all of the time’. A score between
1 and 5 is attributed to each response for each item of the scale and the scores are
then summed to give a total in the range 14–70 (for the full version) or 7–35 (for the
short version).
WEMWBS focuses entirely on positive aspects of mental health with items covering
positive functioning (energy, clear thinking, self acceptance, personal development,
mastery and autonomy), satisfying interpersonal relationships and positive feeling
(feelings of optimism, cheerfulness and relaxation).
Studies that have used
WEMWBS include the Scottish Health Survey (2008) and the North West Mental
Wellbeing Survey 2009. The scale was also used in the Health Survey for England
2010.
Both the Scottish and the North West studies provided invaluable data on the
prevalence of mental wellbeing and the factors which impact on this within those
jurisdictions. The data also serve as a baseline assessment against which the efficacy
of community initiatives to improve mental wellbeing can be measured. Within the
Bailiwick, the WEMWBS data collected as part of the GEWS could serve a similar
function, as an important key performance indicator for SSP policy objectives.
A total WEMWBS score for each respondent was calculated by summing the scores
for all 14 items. If a respondent left one or two items blank the blanks were filled in
using the mean score from the remaining completed items, so that a total could still be
calculated. If more than two item scores were missing no total was calculated and the
data were treated as missing. It was possible to calculate total scores for 715
responses. Seven were excluded because of missing data.
HADS
The HADS is a 14 item scale with two embedded subscales screening for anxiety and
depression symptoms. Responses to each of the 14 items are allocated a score
between 0 and 3, and these are summed so as to give an overall HADS score in the
range 0–42 and two separate subscale scores, one for depression, the other for
anxiety, each in the range 0–21.
Similarly to the WEMWBS scale, where a respondent failed to complete one item of
either subscale of the HADS, the mean score from their other responses in the same
subscale was used to fill the blank, to allow a total to be calculated. Where more than
one response was missing from a subscale, the respondent’s data was excluded.
Using clinical cut-offs of ≥ 11/21 for both the depression and the anxiety scales,
responses were designated as either ‘cases’ or ‘non-cases’.
5
Respondents’ Views and Preferences on Adult Mental Health Services
In addition to the validated tools described above, a brief questionnaire was included
comprising questions about what types of Primary Care Psychological Therapy
services respondents would consider useful or desirable (appendix 2). At the end of
this questionnaire a section was provided for qualitative feedback where respondents
could express their views and preferences regarding accessing Primary Care
Psychological Therapy services in general. In the planning stage feedback from local
advocacy/service user groups (Mind and the Mental Health Service Users Group) was
received, and this was incorporated into the design of the survey schedule and the
accompanying leaflet.
3.4
Ethical Approval
Ethical approval for the GEWS was sought and obtained from the Ethics Committee of
Guernsey’s Health and Social Services Department.
3.5
Weighting
In order to ensure the sample was representative of the population of Guernsey and
Alderney, data were weighted by both sex and age to achieve a match with the known
demographic profile of the island populations, as estimated at the end of March 20092.
2
Source: States Policy Council Annual Population Bulletin 2009.
6
4.0
Results
Of the 2761 surveys that were sent out, 722 were completed and returned, giving a
26% total response rate.
4.1
Respondent Characteristics
97.2% of respondents were resident in Guernsey, with 2.8% residing in Alderney.
60.7% were female and 39.3% male. Returns across age groups varied, with the
smallest group being the 16–24 year-olds at 6.7% and 55–64 year olds representing
the largest group at 21.9%. The majority of the sample owned their own house outright
(45.1%) or with a mortgage (32%). 57.2% of respondents were in work, 29.9% retired
and 2.2% were unemployed. The majority were married or living with a partner
(70.1%), with largely equivalent numbers of ‘single’ (14.3%) and ‘widowed/divorced’ or
‘separated’ (15.6%) respondents. The spread of household income among
respondents was relatively even, as was level of formal education (see Figures 2 and
3).
Figure 1: Gross Household Income of Respondents
10%
3%
<£5000K
11%
£5K-£15K
12%
£15K-£30K
16%
5%
£30K-£45K
£45K-£60K
£60K-£75K
12%
£75K-£90K
17%
14%
£90K+
Don’t Know
Comparing the above distribution with other similar Guernsey surveys (e.g. the
Guernsey Household Expenditure Survey (2005) and the Guernsey Healthy Lifestyle
Survey (2008)) suggests that the distribution of the gross household income
respondent sample is representative of that of Guernsey and Alderney.
Figure 2: Highest Level of Formal Education Attained By Respondents
26%
29%
No formal qualifications
O/A Level, GNVQ, GCSE
Degree level or higher
45%
The proportion of those with no formal qualifications (29%), Secondary Level
qualifications (45%) and Degree level or higher qualifications (26%) are similar to
rates reported in the Channel Islands more generally, for example rates of 22%, 49%
and 22% in the Jersey Annual Social Survey (2009).
13% of respondents reported having had contact with the Adult Mental Health Service
in the past, whilst just under 2% reported that they were in contact with this service at
the time of completing the survey.
4.2
Self-Perceived Health
All respondents were asked to rate their health in general as either ‘very good’, ‘good’,
‘fair, ‘poor’ or ‘very poor’. Self-assessed health is a useful measure of how an
individual regards their own condition generally and is known to be related to the
incidence of disease and has been found to predict both hospital admission and
mortality (Idler and Benyamini 1997; Hanlon et al 2007). The Scottish Health surveys
in 2008 and 2009 used a similar scale, allowing broad comparisons to be made.
Overall 78% of respondents in Guernsey and Alderney rated their health as ‘very
good’ or ‘good’. This was similar to Scottish figures of 76% (2008) and 77% (2009).
Almost twice as many Scottish respondents (7%), however, reported their health as
being ‘very poor’ or ‘poor’ as compared with only 4% of Guernsey and Alderney
residents. As in the Scottish Health surveys, self-perceived health varied little with sex
but did decrease with age with 2% of those in the 16–24 age group reporting ‘poor’ or
‘very poor’ health as compared with 10% of the 75 year or over group3.
3
Non-responder bias, a type of error introduced if survey responders differ in the variable being
measured from those who do not respond, is more likely to have affected the Guernsey Emotional
Wellbeing Survey than the Scottish Health Survey (2008) or the North West Mental Wellbeing Survey
2009. This is because the Guernsey survey used a postal design, where respondents were selfselecting, whereas the other two surveys were conducted by interview, a process likely to have
4.3
Emotional Wellbeing: The Warwick-Edinburgh Mental Wellbeing Scale
WEMWBS scores were recorded in the range 17 to 70 and the mean score was found
to be 50.53 with a standard deviation of 9.91 (see Tables). Mean score did not differ
significantly according to sex (mean score for males 51.0 and 50.0 for females) and
were similar to mean WEMWBS scores assessed in other areas.
Guernsey EWS (2010)
Scottish Health Survey (2008)
Scottish Health Survey (2009)
Mean WEBWMS Scores
Men
Women
51.0
50.0
50.2
49.7
49.9
49.7
A moderate ceiling effect was noted at the highest possible score, 70, suggesting the
WEMWBS tool had a reduced ability to differentiate between individuals who had very
high levels of mental wellbeing. The same effect, though much more marked, was
noted in the North West Survey (2009) where the short, 7-item WEMWBS scale was
used.
As was the case for sex, t-tests showed that there was no significant difference in the
WEMWBS scores of Guernsey and Alderney residents. However, one-way ANOVAs
revealed that WEMWBS score was significantly associated with age, tenure, selfperceived health status, employment status, marital status and level of formal
education. High/higher levels of mental wellbeing were more likely among:
•
•
•
•
•
•
65–74 year olds (with 16–24 year-olds recording the lowest mean score)
Those who own their homes outright (with those living with family recording the
lowest mean score)
Those with self-perceived good health (people reporting ‘poor’ or ‘very poor’
health having the lowest mean score)
Those in work or retired (unemployed having the lowest mean score)
Those who are married or living as a couple (those who are single having the
lowest mean score)
Those educated to degree level or higher (those with GCSE/A level or
equivalent having the lowest mean score).
In accordance with recommendations of the scale designers, scores were categorised
as ‘Low Wellbeing’ (a mean score of less than one standard deviation below the mean
for the sample population), ‘Moderate Wellbeing’ (a mean score within one standard
deviation from the mean) or ‘High Wellbeing’ (a mean score greater than one standard
deviation above the mean).
Overall, 17% of respondents were classified as having High Wellbeing, 67% as having
Moderate and 16% as having Low Wellbeing. Similar wellbeing distributions have
been recorded in population studies from other areas, for example the North-West of
England (where 20% were classified as having High Wellbeing) and Scotland (where
14% had High Wellbeing).
captured data on a more representative subset of the general population. Comparisons, though by no
means invalidated, should be interpreted with this caveat in mind.
9
Moderate
Mental Well-being
Low
Mental
Well-being
High
Mental
Well-being
Mean= 50.53
Whilst in the 16–24 year age group there were very few individuals who recorded a
high wellbeing score, this result must be interpreted with caution. The number of
respondents in this group was small (n= 47) and it is unclear whether they accurately
represent other people in their age group.
Of note was the association between being unemployed, having a low income and
Low Mental Wellbeing. Overall, 53% of the unemployed group versus 18% of those in
work were classified as having Low Mental Wellbeing. This equates to a relative risk of
3.01 (three times greater risk) for those who are unemployed. It is not possible to infer
the direction of causation. In other words it may be that the unemployed are out of
work because of their low mental wellbeing, or, alternatively, it could be that low
mental wellbeing developed as a consequence of being unemployed. No person in
the lowest income group was classified as having High Mental Wellbeing. The
distributions of Low, Moderate or High Mental Wellbeing Scores by sex, age, level of
formal education level, marital status, income group and employment status are
shown in appendix 3.
4.4
Experience of Symptoms of Common Mental Health Disorders: The
Hospital Anxiety and Depression Scale (HADS).
Analysis of the HADS scores showed that 21% of survey respondents met the cut-off
for experiencing anxiety and/or depression to ‘clinical levels’. Anxiety was more
common than depression, with 20% and 5% meeting caseness respectively; 5%
exhibited co-morbidity for both conditions. There were no overall differences noted
according to sex. The reported rates of experiencing common mental health disorders
in the 16–24 year age group were, as with the mental wellbeing scores, higher than in
other studies, although caution must again be exercised due to the small size of this
group. Generally, across all age groups, levels of reported caseness for men were
higher than those reported in other studies. Self-reported incidence of common mental
health disorders according to age, marital status, sex, level of formal education and
gross household income are also shown in appendix 3.
The association of lower mental wellbeing with unemployment and low income, as
recorded by the WEMWBS was replicated in results from the HADS. 21% of the
unemployed group reported experiencing anxiety and depression, whereas the same
could be said for only 5% of the people who were in work (a risk ratio of 4.24:1) and
the lowest income group reported the greatest incidence of self-reported anxiety and
depression symptoms (18% meeting caseness).
Overall, these figures are slightly higher when compared to those which have been
reported, for example, in Jersey (where 15% showed signs of anxiety or depression in
the Jersey Annual Social Survey 2009) or in the UK (where 17.6% showed signs of at
least one common mental disorder in the national Adult Psychiatric Morbidity Survey
2007). Whilst we must allow for the possibility that difference in survey designs
resulted in different respondent profiles — the Guernsey survey was postal, the Jersey
Annual Social Survey postal with a reminder and the Adult Psychiatric Morbidity
Survey interview-based — the scale of difference in the estimated prevalence figures
suggests we may be looking at a true result for Guernsey.
Only 5% of those meeting caseness criteria for anxiety or depression reported that
they were in contact with mental health services. This figure is lower than in the UK
(e.g. the finding from the survey Adult Psychiatric Morbidity in England, 2007 that 24%
of people with a common mental health disorder were in receipt of treatment for an
emotional problem). Whilst this differential could be attributed to the lack of Primary
Mental Health care on the Islands, it is important to note that the Guernsey figure does
not take into accounts people who were receiving medication (e.g. an anti-depressant)
from their General Practitioner.
13% of people reported that they had had past contact with mental health services.
There were no differences according to sex or age. 37% of those in the lowest income
group reported that they had been in contact with mental health services in the past.
4.5
Mental Ill-health and Mental Wellbeing
It has been suggested (e.g. Keyes 2005) that positive mental health is not simply the
absence of mental ill-health but should be thought of as a complete state in which
individuals are not only free of psychopathology but also ‘flourishing’ , with high levels
of emotional, psychological and social wellbeing. The GEWS results support this
notion as 26% of those respondents who reported having low mental wellbeing did not
experience either anxiety or depression.
4.6
Views and Preferences regarding Adult Mental Health Services
11
Asked where they would like to be seen if referred for help and support for common
issues such as stress, anxiety or depression, 67% of respondents (n= 435) stated a
preference for service provision at their GP surgery. 28% (n= 146) said they would like
to be seen at the Princess Elizabeth Hospital (local Acute hospital) and 11% (n= 55)
expressed the view that other community centres would be appropriate. Only 10% (n=
51) said they would be willing to be seen at the Castel Hospital (local Adult Mental
Health hospital).
In terms of modality of intervention, most respondents expressed a preference for
face-to-face sessions (69%, n= 377) with only a minority being willing to utilise email
(12%, n= 60) or telephone sessions (10%, n= 50).
Almost three-quarters of respondents (74%, n= 466) endorsed that hearing about
other people’s experience of mental health problems would be helpful. 65% of people
(n= 389) expressed the view that accessing a relevant website would be helpful and
57% (n= 342) endorsed that attending a workshop would be useful.
4.7
Qualitative data
Respondents to the GEWS were given space to provide any other feedback or views
on the future of mental health services in Guernsey and Alderney. One in three
respondents (n= 237) made comments. Content analysis of the feedback was
performed. Themes referred to more than once are shown below, in order of
frequency.
12
Feedback content
Castel hospital — criticism, predominantly relating to
state of buildings
Importance of public acceptance/increased awareness
of MH conditions/need to publicise MH issues and
reduce stigma
Over-prescription of drugs/drugs not the answer
Importance of timely treatment/waiting times too long
Praise for MH service/staff/GEWS survey
Need for alternative therapies/holistic
approach/exercise and recreation therapies
Cost of accessing good MH services privately
Work stress
Understaffing within MH services
Desire for helpline/crisis contact/buddy system
Support for carers
Targeted education for school-aged children (early
education about MH)
Importance of face-to-face treatment options
Poor service provision for Alderney
A more discreet service needed
Link between drug/alcohol and MH/need for more
services for alcohol/drug problems
Need for staff continuity/longer housing licences
Desire/support for therapy at GP/community level
Dedicated/separate addiction/detox service
Frequency
25
20
17
12
11
11
9
9
8
7
7
7
6
6
5
5
3
3
2
*MH = mental health
A selection of comments is given below:
“I think there should be more support and information available for families and
carers. The person with the mental health problem is not always the only one
affected.”
“Work/home balance needs consideration — there is an unwritten expectation in
Guernsey that work comes first and it shouldn’t.”
“Mental health is still perceived as a taboo subject.
understanding and empathy would be good.”
Greater public awareness,
“Like most places, too much emphasis is placed on drug therapy. What is needed is
more one-to-one sessions.”
“The [Castel Hospital] staff do an amazing job in a building not fit for purpose.”
13
5.0
Summary and Conclusions
This report provides the key descriptive statistics derived from the GEWS. The
possibilities for investigating the data in more detail are numerous. However, the
results presented here provide a first stage analysis that, in keeping with the aims of
the survey, gives a baseline for the level of mental wellbeing among Guernsey and
Alderney residents, and provides an estimate, made for the first time from local data,
of the prevalence of mild to moderate anxiety and depression disorders within the
Bailiwick.
Results revealed a mean WEMWBS score of 50.53 and a distribution of wellbeing
scores that saw 16% or respondents classified as having low mental wellbeing, 67%
as having moderate wellbeing and 17% as having high wellbeing. Although these
results are similar to those found for other regions, such as the North West of
England, and Scotland, results from the second measure, the HADS, used here to
gauge symptomatology for anxiety and/or depression to clinical levels, suggests that
mental ill-health is experienced at least as frequently in the Bailiwick.
The proportion of respondents whose HADS scores put them above the clinical cutoffs for anxiety and or depression was 21%, or one in five, which is slightly higher
relative to recent estimates for Jersey and the UK. Moreover, significant variations in
both HADS and WEMWBS scores were detected among certain subsets of the survey
respondents. Increased likelihood of low mental wellbeing and anxiety/depression
symptomatology was found for those with low incomes and those who were
unemployed, for example. The youngest respondents, those aged 16–24, though
relatively few in number in this survey, also emerged as possibly a vulnerable group,
who could be particularly at risk of experiencing mental ill-health and low mental
wellbeing, on account of their having a lower mean WEMWBS score and an increased
propensity for anxiety and depression symptoms.
The strong associations noted above, between mental wellbeing and age, work status
and household income, merit further investigation and highlight the potential for
investigating the GEWS data in greater depth, using, for example, multivariate
analyses which are beyond the scope of this report.
These findings support the case for the local development of specific mental health
services which are able to provide a full range of evidence-based therapies for mild to
moderate anxiety and depression. Adopting such an early intervention approach as an
integral part of the emerging Mental Health Strategy would serve an important
preventative function, potentially providing savings from Social Security sickness and
incapacity budgets and Health and Social Services spending on long-term mental
health care. Most importantly, however, the provision of such services would enable
people in distress to access services aimed not only at reducing mental ill-health but
also at promoting positive mental wellbeing.
Now that baseline WEMWBS and HADS score distributions have been established, it
would be straightforward to measure progress in improving mental wellbeing by
repeating the survey in the future using the same methodology.
14
6.0
Limitations
The current study was limited to a convenience sample, the postal design of which
contributed to a low response rate of just 26%. The impact of possible non-responder
bias must therefore be considered. The self-report method of completion used in the
study may also have introduced bias since, it could be argued, individuals may not
always best placed to evaluate their own mental health and wellbeing, but, instead,
could additionally benefit from the opinions of relatives, friends or clinicians. If in the
future resources allow, the replication of the study using clinical interviews to collect
data should be considered. An interview-based design would reduce the limitations
encountered in this study and would shed light on the extent to which the current
findings can be generalized to the wider populations of Guernsey and Alderney.
Despite the limitations enumerated above, the completion of the GEWS has served as
an essential first step in mental health and wellbeing research in the Bailiwick of
Guernsey and, it is hoped, will be the model for further local research in this important
area.
15
7.0 References
Billet d’État XXVI Tuesday 27th October 2009, Policy Council States Strategic Plan
2009–2013. The States of Guernsey.
Bridgman, S. (2010) Prevalence of Mental Health Conditions. HSSD.
Corbett, J., Given, L., Leyland, A., MacGregor, A., Marryat, L., Miller, M. and Reid, S.
(2009) The Scottish Health Survey 2008. The Scottish Government.
Danner, D., Snowdon, D. & Friesen, W. (2001). Positive emotions in early life and
longevity: Findings from the Nun Study. Journal of Personality and Social Psychology,
80, 668-678.
Deacon, L., Carlin, H., Spalding, J., Giles, S., Stansfield, J., Hughes, S., Perkins, C. &
Bellis, M. (2009). North West Mental Wellbeing Survey 2009 Summary. North West
Public Health Observatory.
Foresight Mental Capital and Wellbeing Project (2008).Final Project report – Executive
summary. The Government Office for Science, London.
Guernsey Annual Population Bulletin 2009, Policy Council, The States of Guernsey.
Hanlon, P., Lawder, R., Elders, A., Clark, D., Walsh, D., Whyte, B. & Sutton, M.
(2007). An analysis of the link between behavioural, biological and social risk factors
and subsequent hospital admission in Scotland. Journal of Public Health, 29, 405-12.
Health and Social Care Advisory Service (2008). A report on Guernsey Adult Acute
Mental Health Services.
Health and Social Care Information Service (2009). Adult Psychiatric Morbidity in
England, 2007: Results of a Household Survey.
Huppert, F. (2005). Positive mental health in individuals and populations. In F Huppert,
Baylis & Keverne (Eds.) The Science of Well-being (pp.307-40). Oxford: Oxford
University Press.
Huppert, F. (2009). Psychological well-being: Evidence regarding its causes and
consequences. Applied Psychology: Health and Well-being, 1(2), 137-64.
Idler, E. and Benyamini (1997). Self-rated health and mortality: a review of twentyseven community studies. Journal of Health and Social Behaviour, 38 (1), 21-37.
Keyes, C. (2005). Mental Illness and/or mental health? Investigating axioms of the
complete state model of health. Journal of Consulting and Clinical Psychology, 73(30
539-548.
Snaith, R. and Zigmond, A. (1983). The hospital anxiety and depression scale. Acta
Psychiatrica Scandinavica. 67(6), 361-70.
Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., Parkinson, J.,
Secker, J. and Stewart-Brown, S. (2007) The Warwick-Edinburgh Mental Wellbeing
16
Scale (WEMWBS): development and UK validation. Health and Quality of Life
Outcomes, 5 63-76.
World Health Organisation (2001) World Health Report.
17
Appendix 1: Accompanying Leaflet
Appendix 2: Questionnaire
18
Emotional Health and Wellbeing Survey-2010
*********All answers you provide are anonymous and confidential*********
Below are some statements about feelings and thoughts.
Please tick the box that best describes your experience of each over the last 2 weeks
None
of the
time
Rarely
Some
of the
time
Often
All of
the time
1. I’ve been feeling optimistic about the
future
1
2
3
4
5
2. I’ve been feeling useful
1
2
3
4
5
3. I’ve been feeling relaxed
1
2
3
4
5
4. I’ve been feeling interested in other
people
1
2
3
4
5
5. I’ve had energy to spare
1
2
3
4
5
6. I’ve been dealing with problems well
1
2
3
4
5
7. I’ve been thinking clearly
1
2
3
4
5
8. I’ve been feeling good about myself
1
2
3
4
5
9. I’ve been feeling close to other people
1
2
3
4
5
10. I’ve been feeling confident
1
2
3
4
5
11. I’ve been able to make up my own
mind about things
1
2
3
4
5
12. I’ve been feeling loved
1
2
3
4
5
13. I’ve been interested in new things
1
2
3
4
5
14. I’ve been feeling cheerful
1
2
3
4
5
STATEMENTS
Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)
© NHS Health Scotland, University of Warwick and University of Edinburgh, 2006, all
rights reserved.
Please read each item below and put a cross in the box which comes closest to how you have
been feeling in the past week. Don’t take too long over your replies, your immediate reaction to
each item will probably be more accurate than a long thought-out response.
19
15. I feel tense or ‘wound up’
Most of the time
A lot of the time
From time to time, occasionally
Not at all
22. I feel as if I am slowed down
Nearly all the time
Very often
Sometimes
Not at all
16. I still enjoy the things I used to enjoy
Definitely as much
Not quite as much
Only a little
Hardly at all
23. I get a sort of frightened feeling like
‘butterflies’ in the stomach
Not at all
Occasionally
Quite often
Very often
17. I get a sort of frightened feeling as if
something awful is about to happen
Very definitely and quite badly
Yes, but not too badly
A little, but it doesn’t worry me
Not at all
24. I have lost interest in my appearance
Definitely
I don’t take as much care as I should I may not take quite as much care
I take just as much care as ever
18. I can laugh and see the funny side of
things
As much as I always could
Not quite as much now
Definitely not as much now
Not at all
25. I feel restless as if I have to be on the
move
Very much indeed
Quite a lot
Not very much
Not at all
19. Worrying thoughts go through my
mind
A great deal of the time
A lot of the time
Not too often
Very little
26. I look forward with enjoyment to things
As much as I ever did
Rather less than I used to
Definitely less than I used to
Hardly at all
20. I feel cheerful
Never
Not often
Sometimes
Most of the time
27. I get sudden feelings of panic
Very often indeed
Quite often
Not very often
Not at all
21. I can sit at ease and feel relaxed
Definitely
Usually
Not often
Not at all
28. I can enjoy a good book or radio or
television programme
Often
Sometimes
Not often
Very seldom
©HADS: RP Snaith & AS Zigmond, 1983, 1992, 1994. Used with permission from GL Assessment.
Your Experiences and Views…..
Place a cross in the relevant boxes
Yes No
29. Have you had contact in the past with the mental health
services at the Castel Hospital?
Yes No
20
30. Are you currently in contact with the mental health services
at the Castel Hospital?
31. If you were referred for help and support for common issues such as stress,
anxiety or depression would you like to be seen….
Yes No I Don’t Mind
At your GP surgery?
At a setting such as Beau Sejour or
St Martin’s Community Centre?
At the Princess Elizabeth Hospital?
At the Castel Hospital?
Via face-to-face individual sessions?
Via Telephone contact?
Via Email contact?
32. Which of the following do you think would also be useful for people referred to
such a service?
Yes
No I Don’t Know
A website with relevant mental health
information
An evening class/workshop on mental
health topics (stress management,
‘manage your mood’ tips etc)
Being able to read about other people’s
experiences and what helped for them
33. We are interested in your views and perspectives on the future of mental health
services in Guernsey and Alderney. If you have any other feedback or views
please add them here.
Please turn over to the last page………………………
21
*********All answers you provide are anonymous and confidential*********
34.
Do you live in?
Guernsey
Alderney
35.
Are you?
Male
Female
36.
How old are you?
16-24 25-34 35-44 45-54 55-64 65-74 75+ 37.
Do you?
38.
How would you describe your general health? (please mark one box only)
Own your own home outright
Have a mortgage
Live with family
Rent
Very good
Good
Fair
Poor
Very Poor
Retired
Other
39.
Are you?
In work
Student
Unemployed
40.
Are you?
Single
Married/Living as a couple
Widowed/Divorced/Separated
41.
Which band does your gross household income fall within?
Less than £5000
£5000-£14999
£15000-£29999
£30000-£44999
Don’t know
42.
£45000-£59999
£60000-£74999
£75000-£89999
£90000+
What is your level of formal educational qualification?
No formal qualifications
‘O’ Level, ‘A’ Level, GNVQs or GCSEs
Degree level or higher
Thank you for taking the time to complete this questionnaire.
If completing the questionnaire has caused you any distress or raised emotional
issues for which you would like help please contact Dr Sara Johnson at the
Primary Care Psychological Therapies Service on 725241 extension 3368.
22
Appendix 3: Summary Data
Key:
None
Anxiety Only
Depression Only
Anxiety & Depression
HADS Anxiety and Depression Caseness
79%
16%
9% 5%
Mean Anxiety Score= 6.75
Mean Depression Score=4.19
All Respondents
(a) Sex
(b)
Females
78%
18%
Males
79%
14% 1%
1%
3%
6%
Mean A:
Anxiety
6.91 Score=
Mean D:
Depression
4.09
Score=
Mean A: 6.58
Mean D: 4.29
Formal Education Level
Degree or Higher
O Level A Level,
GNVQ or GCSE
No Formal
Qualifications
83%
77%
80%
14% 1%
18%
1%
14% 0
2%
Mean A: 6.14
Mean D: 3.51
5%
Mean A: 7.22
Mean D: 4.27
6%
Mean A: 6.58
Mean D: 4.58
23
(c) Age Group
Key:
None
Anxiety Only
Depression Only
1%
75+
90%
65-75
7%
11% 1%
87%
55-64
14%
81%
45-54
75%
35-44
74%
18%
1%
1%
1%
Anxiety & Depression
Mean A: 4.81
Mean D : 4.26
1%
Mean A: 5.50
Mean D: 3.76
4%
Mean A: 6.80
Mean D: 4.00
Mean A: 7.27
6% Mean D: 4.74
Mean A: 7.59
25-34
18%
21%
72%
16-24
60%
34%
(d) Marital Status
Divorced,
Widowed,
Separated
Married/Li
ving with a
Partner
Single
0%
2%5%
2% 9%
8% Mean D: 4.48
Mean A: 7.52
Mean D: 3.82
Mean A: 8.8
Mean D: 3.84
(e) Employment Status
74%
13% 2%
11%
Mean A: 6.79
Mean D: 5.21
Other
67%
Retired
82%
68%
15% 1%
24%
2%
3%
Mean A: 6.46
Mean D: 3.86
6%
Mean A: 8.17
Mean D: 4.72
Unemployed
Student
In Work
19% 0%
90%
71%
63%
75%
7%
0%
14%
Mean A: 8.30
Mean D: 5.92
1%
8%
1%
Mean A: 5.09
Mean D: 3.69
21%
31%
6% 0%
19% 1% 5%
Mean A: 8.06
Mean D: 7.04
Mean A: 8.76
Mean D: 3.92
Mean A: 7.30
Mean D: 4.14
24
(f) Gross Household Income
Key:
Don’t Know
79%
£90000+
78%
£75000-£89999
Depression Only
Mean Anxiety Score: 7.42
Mean Depression Score: 4.42
1%
4%
Mean Anxiety Score: 6.40
Mean Depression Score: 3.59
0
3%
Mean Anxiety Score: 6.51
Mean Depression Score: 3.98
2%
2%
Mean Anxiety Score: 6.66
Mean Depression Score: 4.18
0
2%
Mean Anxiety Score: 6.56
Mean Depression Score: 3.32
6%
Mean Anxiety Score: 7.36
Mean Depression Score: 4.21
0
5%
Mean Anxiety Score: 6.39
Mean Depression Score: 4.36
3%
5%
Mean Anxiety Score: 6.55
Mean Depression Score: 5.21
18%
Mean Anxiety Score: 6.49
Mean Depression Score: 5.79
24%
15%
14%
76%
18%
83%
71%
76%
12%
21%
0%6%
Anxiety & Depression
6%
2%
17%
84%
£15000-£29999
<£5000
13%
82%
£45000-£59999
£5000-£14999
Anxiety Only
74%
£60000-£74999
£30000-£44999
None
0
25
WEMWBS
Key:
Low Mental Well-being
16.30%
Moderate Mental Well-being
70.10%
High Mental Well-being
16.70%
Mean Score: 50.53
All Respondents
(a) Sex
Females
Males
15%
67%
17%
18%
68%
15%
Mean Score: 50.0
Mean Score: 51.0
(b) Formal Education Level
Degree or
Higher
O Level A
Level, GNVQ
or GCSE
No Formal
Qualifications
9%
73%
17%
20%
18%
68%
61%
15%
19%
Mean Score: 52.5
Mean Score: 49.7
Mean Score: 50.1
26
(c)
Age
Key:
75+
65-75
Low Mental Well-being
9%
71%
5%
55-64
16%
68%
20%
16-24
Married/Li
ving with
a Partner
74%
4%
Mean Score: 46.4
(e) Employment Status
Other
23%
12%
62%
70%
15%
18%
Mean Score: 48.9
Mean Score: 51.5
28%
60%
12% Mean Score: 47.2
25%
60%
Retired 8%
Unemployed
Student
Single
Mean Score: 51.3
19%
(d) Marital Status
Divorced,
Widowed,
Separated
Mean Score: 48.7
14%
63%
21%
Mean Score:48.6
10%
67%
18%
Mean Score:50.9
18%
22%
35-44
Mean Score: 54.0
27%
65%
High Mental Well-being
Mean Score: 52.4
20%
65%
45-54
25-34
Moderate Mental Well-being
In Work
68%
24%
53%
25%
18%
15%
33%
69%
69%
13%
Mean Score: 46.7
Mean Score: 53.9
Mean Score: 41.7
6%
Mean Score: 48.1
13%
Mean Score: 49.7
27
Key:
Low Mental Well-being
Moderate Mental Well-being
High Mental Well-being
(f) Gross Household Income
Don’t Know
16%
£90000+
£75000-£89999
£60000-£74999
£45000-£59999
70%
14%
74%
6%
16%
£15000-£29999
17%
£5000-£14999
<£5000
Mean Score: 50.9
16%
57%
28%
Mean Score: 51.2
13%
68%
24%
Mean Score: 51.7
23%
77%
£30000-£44999
Mean Score: 52.0
18%
61%
10%
Mean Score: 51.1
12%
76%
16%
Mean Score: 48.6
14%
Mean Score: 51.2
26%
59%
Mean Score: 49.2
16%
72%
0%
Mean Score: 44.9
28
Table 1 WEMWBS Score by Self-Assessed Health Status, Sex and Age.
Self Perceived Health 16-24
25-34
35-44
45-54
55-64
65-74
75+
Total
%
%
%
%
%
%
%
%
Males
Very good
25
41
43
39
21
38
23
33
Good
46
48
31
39
48
42
39
41
Fair
29
10
20
19
21
16
23
19
Poor
0
0
6
1
10
4
16
6
Very poor
0
0
0
1
0
0
0
0
Females
Very good
22
44
31
41
38
25
4
30
Good
61
33
56
45
45
59
56
51
Fair
13
22
10
12
16
10
34
16
Poor
0
0
4
3
1
5
6
3
Very Poor
4
0
0
0
0
0
0
0
All
Very good
23
44
37
39
30
32
12
32
Good
54
40
44
42
46
50
49
46
Fair
21
16
15
15
18
13
29
18
Poor
0
0
4
3
6
4
10
4
Very Poor
2
0
0
1
0
0
0
0
24
23
47
29
28
57
50
52
102
70
70
140
66
77
143
56
59
115
31
51
82
326
359
685
21
26
47
21
36
57
35
67
102
49
91
140
58
94
152
50
65
115
38
44
82
272
423
695
Bases (weighted):
Males
Females
All
Bases (unweighted):
Males
Females
All
29
Table 2 WEBWMS Scores by Age and Sex
16-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Mean
45.2
52.4
48.4
48.1
49.7
53.1
53.7
50.0
SE of the Mean
1.4
1.7
1.2
1.0
1.4
1.3
1.6
0.5
Standard Deviation
6.92
9.17
8.68
8.66
10.94
9.90
8.71
9.58
Mean
47.7
50.2
49.0
49.1
52
55
51.6
51.0
SE of the Mean
2.3
1.8
1.3
1.3
1.3
1.1
1.4
0.5
10.82
9.52
9.20
10.94
11.13
8.28
9.58
10.20
Mean
46.4
51.3
48.7
48.6
50.9
54.0
52.4
50.5
SE of the Mean
1.32
1.24
0.88
0.83
0.93
0.85
1.03
0.38
Standard Deviation
9.02
9.33
8.91
9.84
11.06
9.13
9.25
9.91
Bases (Weighted)
Males
Females
All
24
23
47
29
28
57
50
52
102
70
70
140
66
76
142
57
58
115
31
50
81
327
356
683
Bases (Unweighted)
Males
Females
All
21
26
47
21
36
57
35
67
102
49
91
140
58
93
151
52
64
116
37
43
80
272
420
692
WEMWBS Scores
Males
Females
Standard Deviation
All
30
Table 3: WEBWMS Scores by Formal Education Level and Sex
No Formal
Qualifications
O Level A Level,
GNVQ or GCSE
Degree or
Higher
Total
Mean
49.84
49.22
51.46
50.02
SE of the Mean
1.09
0.75
0.96
0.53
Standard Deviation
10.8
8.9
9.12
9.58
Mean
50.24
50.21
53.72
51.04
SE of the Mean
1.08
0.80
0.89
0.54
Standard Deviation
11.38
10.08
8.15
10.19
Mean
50.05
49.74
52.54
50.55
SE of the Mean
0.77
0.55
0.66
0.38
Standard Deviation
11.09
9.55
8.72
9.90
Bases (Weighted)
Males
Females
All
97
111
208
140
158
298
90
82
172
327
352
679
Bases (Unweighted)
Males
Females
All
82
121
203
115
193
308
75
102
177
272
416
688
WEMWBS Scores
Males
Females
All
31
Table 4: WEBMWS Scores by Marital Status and Sex
Single
Married/Living
with a Partner
Divorced,
Widowed,
Separated
Total
Mean
48.44
50.82
46.79
49.97
SE of the Mean
1.27
0.58
2.22
.53
Standard Deviation
9.5
8.8
13.2
9.6
Mean
45.73
52.25
50.01
50.98
SE of the Mean
1.70
0.62
1.24
0.54
Standard Deviation
11.4
9.6
10.4
10.2
Mean
47.23
51.54
48.93
50.50
SE of the Mean
1.04
0.42
1.11
0.38
Standard Deviation
10.4
9.2
11.4
9.9
Bases (Weighted)
Males
Females
All
56
45
101
234
240
474
35
70
105
325
355
680
Bases (Unweighted)
Males
Females
All
46
53
99
194
290
484
31
76
107
271
419
690
WEMWBS Scores
Males
Females
All
32
Table 5: WEMWBS Scores by Employment Status and Sex
In Work
Student
Unemployed
Retired
Other
Total
Mean
49.46
46.13
44.35
53.79
36.24
49.96
SE of the Mean
0.61
3.31
3.88
0.93
3.20
0.53
Standard
Deviation
8.7
10.0
11.3
8.8
10.9
9.5
Mean
50.01
50.75
38.23
53.94
49.72
51.02
SE of the Mean
0.72
2.80
6.32
0.88
1.74
0.54
Standard
Deviation
10.0
7.4
16.0
9.3
11.0
10.2
Mean
49.72
48.13
41.72
53.87
46.68
50.51
SE of the Mean
0.47
2.24
3.46
0.64
1.71
0.38
Standard
Deviation
9.3
9.0
13.3
9.0
12.2
9.9
Bases
(Weighted)
Males
Females
All
206
189
395
9
7
16
8
6
14
90
112
202
12
40
52
326
355
681
Bases
(Unweighted)
Males
Females
All
171
239
410
8
8
16
8
8
16
95
116
211
10
49
59
293
419
712
WEMWBS
Scores
Males
Females
All
33
Table 6: WEBWMS Scores by Income and Sex
<£5000
£5000£14999
£15000£29999
£30000£44999
£45000£59999
£60000£74999
£75000£89999
£90000+
Don’t Know
Total
47.78
4.42
11.3
45.54
2.55
13.0
49.29
1.57
11.2
50.68
1.15
9.1
51.28
0.98
7.3
49.64
1.77
10.1
52.06
2.00
8.2
50.42
1.38
9.2
51.46
1.48
7.8
50.09
0.53
9.6
43.28
3.38
11.8
51.08
1.47
10.3
52.71
1.33
10.8
51.18
1.21
9.2
51.13
1.58
10.3
54.03
1.73
9.3
51.97
2.16
8.9
51.90
1.38
8.4
46.26
1.91
11.4
51.03
0.55
10.2
44.85
2.66
11.5
49.17
1.33
11.5
51.23
1.02
11.0
50.92
.83
9.1
51.22
0.88
8.7
51.72
1.26
9.9
52.01
1.45
8.4
51.09
0.98
8.8
48.55
1.29
10.2
50.58
0.38
9.9
Bases (Weighted)
Males
Females
All
6
12
18
26
49
75
51
66
117
62
58
120
55
43
98
32
29
61
17
17
34
45
37
82
27
35
62
322
346
668
Bases
(Unweighted)
Males
Females
All
6
13
19
24
51
75
44
75
119
51
71
122
44
53
97
25
37
62
13
21
34
36
47
83
24
39
63
267
407
674
WEMWBS Scores
Males
Mean
SE of the Mean
Standard Deviation
Females
Mean
SE of the Mean
Standard Deviation
All
Mean
SE of the Mean
Standard Deviation
34
Table 7: HADS Caseness by Age and Sex
16-24
25-34
35-44
45-54
55-64
65-74
75+
Total
%
%
%
%
%
%
%
%
None
63
76
74
74
83
84
94
79
Anxiety Only
33
21
14
14
9
12
6
14
Depression Only
4
0
0
1
0
2
0
1
Anxiety and Depression
0
3
12
10
8
2
0
6
None
57
68
75
75
78
90
90
78
Anxiety Only
35
21
22
22
18
10
6
18
Depression Only
0
4
0
0
1
0
1
1
Anxiety and Depression
9
7
4
3
3
0
1
3
All
None
60
72
74
75
81
87
90
79
Anxiety Only
34
21
18
18
14
11
7
16
Depression Only
2
2
0
1
1
1
1
9
Anxiety and Depression
9
5
8
6
4
1
1
5
Bases (Weighted)
Males
Females
All
24
23
47
29
28
57
50
51
101
66
69
135
66
77
143
57
58
115
31
51
82
323
362
685
Bases (Unweighted)
Males
Females
All
21
26
47
21
36
57
35
66
101
49
90
139
58
94
152
51
64
115
38
48
86
273
424
697
HADS Caseness
Males
Females
35
Table 8: HADS Caseness by Formal Education and Sex
No Formal
Qualifications
O Level A Level,
GNVQ or GCSE
Degree or Higher
Total
%
%
%
%
None
78
76
85
79
Anxiety Only
11
17
12
14
Depression Only
1
1
0
1
Anxiety and Depression
9
6
2
6
None
81
77
80
78
Anxiety Only
16
18
17
18
Depression Only
0
1
1
1
Anxiety and Depression
3
4
2
3
All
None
80
77
83
79
Anxiety Only
14
18
14
16
Depression Only
0
1
1
9
Anxiety and Depression
6
5
2
5
Bases (Weighted)
Males
Females
All
97
112
209
141
158
299
89
83
172
327
353
680
Bases (Unweighted)
Males
Females
All
91
122
213
126
193
319
80
101
181
297
416
713
HADS Caseness
Males
Females
36
Table 9: HADS Caseness by Marital Status and Sex
Single
Married/Living with
a Partner
Divorced, Widowed,
Separated
Total
%
%
%
%
None
71
81
71
79
Anxiety Only
21
14
3
14
Depression Only
2
1
0
1
Anxiety and Depression
5
3
26
6
None
61
83
74
78
Anxiety Only
30
15
19
18
Depression Only
2
0
3
1
Anxiety and Depression
7
2
4
3
All
None
68
82
74
79
Anxiety Only
24
15
13
16
Depression Only
2
1
2
9
Anxiety and Depression
6
3
11
5
Bases (Weighted)
Males
Females
All
56
43
99
236
240
476
35
71
106
327
354
681
Bases (Unweighted)
Males
Females
All
46
55
101
196
307
503
30
81
111
272
443
715
HADS Caseness
Males
Females
37
Table 10: HADS Caseness by Employment Status and Sex
In Work
Student
Unemployed
Retired
Other
Total
%
%
%
%
%
%
None
76
67
88
91
46
79
Anxiety Only
17
22
0
8
9
14
Depression Only
1
11
0
1
0
1
Anxiety and
Depression
7
0
12
0
46
6
None
75
57
50
89
73
78
Anxiety Only
22
43
0
9
22
18
Depression Only
1
0
17
1
0
1
Anxiety and
Depression
3
0
33
1
5
3
All
None
75
63
71
90
67
79
Anxiety Only
19
31
0
8
19
16
Depression Only
0
6
7
1
0
9
Anxiety and
Depression
5
0
21
0
13
5
Bases
(Weighted)
Males
Females
All
207
189
396
9
7
16
8
6
15
91
113
204
12
42
53
327
357
684
Bases
(Unweighted)
Males
Females
All
158
239
397
8
8
16
7
8
15
90
117
207
10
51
61
273
423
696
HADS Caseness
Males
Females
38
Table 11: HADS Caseness by Income and Sex
£15000£29999
%
76
14
0
10
£30000£44999
%
76
14
0
10
£45000£59999
%
88
12
0
0
£60000£74999
%
75
19
3
3
£75000£89999
%
76
18
0
6
£90000+
Don’t Know
Total
%
83
0
0
17
£5000£14999
%
65
15
4
15
%
80
16
2
2
%
90
10
0
0
%
79
14
1
6
73
0
9
18
75
34
2
0
88
11
0
2
74
22
0
3
79
16
0
5
86
14
0
0
71
29
0
0
76
19
0
5
69
17
3
11
78
18
1
3
None
Anxiety Only
Depression Only
Anxiety and Depression
76
0
6
18
71
21
3
5
83
12
0
5
76
18
0
6
84
14
0
2
82
15
2
2
74
24
0
3
78
17
1
4
79
13
2
6
79
16
9
5
Bases (Weighted)
Males
Females
All
6
11
17
26
51
77
50
66
116
63
57
120
56
43
99
32
28
60
17
17
34
44
37
81
29
34
63
320
344
667
Bases (Unweighted)
Males
Females
All
6
11
17
24
54
78
43
82
125
51
78
129
44
54
98
25
39
64
14
22
36
36
50
86
25
39
66
268
429
697
HADS Caseness
Males
None
Anxiety Only
Depression Only
Anxiety and Depression
<£5000
Females
None
Anxiety Only
Depression Only
Anxiety and Depression
All
39