5 Conclusions and recommendations
This analysis used survey data from a large sample of Scottish primary and secondary school pupils, to explore risk and protective factors for children and young people’s mental health and wellbeing. It examined the prevalence of mental health outcomes and related risk and protective factors across five domains of children’s lives: Family, School, Peer, Area and Health. It explored how strongly each of these risk or protective factors was associated with mental health problems and positive mental wellbeing: (a) individually, and (b) after accounting for the influence of other factors.
This chapter presents conclusions and recommendations based on the current research. It first gives an overview of the report’s conclusions, highlighting key findings. It then outlines recommendations, both for future research and for policy and practice.
Numerous factors across different domains of children and young people’s lives contribute to mental health and wellbeing. School experiences and interactions with family members and peers are consistently important for good mental health and wellbeing. Good general health and physical activity are also key. In addition, perceptions of the local area are linked to certain mental health outcomes, but less strongly than other factors. Experiences and relationships across these domains are stronger predictors of mental health and wellbeing than socio-demographic factors, such as area deprivation or family structure. In particular, children and young people with clusters of multiple risk factors are especially vulnerable to mental health problems.
Different mental health and wellbeing outcomes showed stronger associations with different factors. For example, emotional problems were most strongly linked with negative peer experiences, whereas conduct problems were most strongly linked with negative family experiences. However, the same factors were consistently relevant for both poor mental health and positive mental wellbeing. This suggests that focusing on these same experiences (particularly the quality of interactions in family, peer and school settings) may be useful to both tackle mental health problems and also support children to positively thrive.
Despite an overall trend for poorer mental health and wellbeing in more deprived areas, the effect of area deprivation tended to be small or non-existent after accounting for the influence of other factors. This suggests that this deprivation gap in children and young people’s mental health and wellbeing can be explained by underlying inequalities in exposure to risk factors in family, school, peer and neighbourhood environments. Area deprivation therefore seems to be a marker of exposure to multiple risk factors for poor mental health and wellbeing, rather than a driver of wellbeing itself.
Gender differences in mental health and wellbeing were small or non-existent in primary school, but more pronounced in secondary school. Outcomes tended to be worse for boys in terms of conduct, and worse for girls in terms of mental wellbeing and especially emotional problems. The gender gap in emotional problems was particularly notable (consistent with existing evidence) and was still evident after accounting for the fact that girls tended to have poorer peer and school experiences.
Summary: Experiences across various domains of children and young people’s lives contribute to mental health and wellbeing. Positive interactions in family, peer and school settings seem particularly important. Deprivation is a marker of vulnerability to risk factors rather than a driver of poor mental health itself. Gender differences in emotional wellbeing are still evident when comparing boys and girls with similar experiences in these domains.
5.2.1 Future research
This report presents associations between relevant factors and mental wellbeing, but does not provide evidence of what causes these associations. By accounting for child characteristics and the influence of multiple factors at once, this analysis can support evidence of direct links between risk/protective factors and mental health outcomes. However, this does not mean that exposure to the risk factor definitely causes mental health outcomes or vice versa. For example, family conflict may increase children’s risk of mental health problems, but the challenges of child mental health problems may also create family conflict. Longitudinal surveys that follow children over time are particularly useful to better understand the temporality and directionality of these relationships. For example, the Growing Up in Scotland study collects data on around 14,000 of children and their families (as part of different cohorts) and follows them from birth, through childhood to adolescence and beyond. This type of research can provide deeper insight into how experiencing the risk and protective factors identified in this report may influence mental health and wellbeing in children and young people over time.
Since the risk factors examined in the current report could not explain the gender gap in emotional problems, future research should explore other potentially relevant factors to understand why girls have much poorer emotional wellbeing. For example, during the last decade as emotional problems have been increasing amongst girls (especially older girls), social media use has also rapidly increased. It is possible that the widening inequality in emotional wellbeing is partly influenced by differences in how adolescent boys and girls tend to engage with social media. For example, girls tend to prefer photo-based platforms and compare themselves more to others they see on social media.
As well as working to directly target the risk factors identified in this report (e.g. tackling bullying or reducing family conflict), we can also develop a better understanding of what individual child factors may promote resilience for children who are experiencing these risk factors. For example, as well as implementing interventions aimed at improving children’s family environments, it is also valuable to explore what may reduce the impact of a negative family environment on a child’s mental health and wellbeing. This could include children’s sense of control, autonomy or self-esteem, all of which may help make some children more resilient to negative experiences. Future surveys can include established questionnaire measures that capture these aspects of children’s psychological functioning, alongside the types of subjective experiences and perceptions included in the current dataset.
Summary: Future research can make use of longitudinal studies, such as the Growing Up in Scotland study to supplement these findings from RCS. Topics to explore further include the gender gap in young people’s emotional wellbeing and what factors may promote resilience for those exposed to risk factors.
5.2.2 Policy and practice
The findings presented support the need for a holistic understanding of children’s mental health and wellbeing, since multiple factors combine to influence outcomes. This is core to the GIRFEC approach, and reflected in the broad coverage of the SHANARRI wellbeing domains. For example, the results presented here are consistent with the importance of children and young people being “Nurtured” and “Included” (with positive family and peer interactions) to support good mental health and wellbeing.
As noted above, future research (including use of longitudinal datasets) can help to identify what causes these associations. However, the current findings do suggest that mental health and wellbeing in children and young people could be supported by interventions in family and school settings that target multiple factors, with a focus on positive relationships. For example, interventions in family settings can aim to promote positive interactions, open communication and quality time together. Interventions in school settings can tackle bullying, promote good relationships between peers and between pupils and school staff and equip pupils to manage the demands of schoolwork. Given the wide range of important factors identified here, CPPs can explore how different organisations can work together to target these domains within a holistic approach to supporting mental health and wellbeing.
These findings can help practitioners to identify children and young people that are at increased risk of mental health problems. Numerous factors contribute to children and young people’s mental health and wellbeing. Therefore, each individual situation is unique, and various different combinations of these risk factors could lead to problems for different children. However, practitioners can broadly look out for children who are socially isolated or excluded (with experiences of bullying or prejudice, and few friends); children who feel negatively towards school (in terms of both workload and relationships with teachers and pupils); and children who lack positive family relationships and interactions (with family conflict and no trusted adult to confide in). Crucially, rather than focusing overly on any single factor, it is important to remember that those children and young people who have multiple risk factors are most vulnerable to mental health problems.
Summary: These findings support a holistic approach to children and young people’s mental health and wellbeing. Identifying children and young people with clusters of multiple risk factors can target the most vulnerable groups for poor mental health. Interventions in school and family settings that aim to promote good quality relationships with parents, peers and teachers may be effective.