Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS): mental wellbeing report 2018

1 Introduction and background

This report presents the mental wellbeing findings from the 2018 wave of the Scottish Schools Adolescent Lifestyle and Substance Use Survey. The research was commissioned by the Scottish Government and carried out by Ipsos MORI Scotland.

Survey background

SALSUS is a continuation of a long established series of national surveys on smoking, drinking and drug use. These were carried out jointly in Scotland and England between 1982 and 2000, to provide a national picture of young peoples' smoking (from 1982), drinking (from 1990) and drug use (from 1998) within the context of other lifestyle, health and social factors. Since 2002, Scotland has developed its own, more tailored survey known as SALSUS. SALSUS also collects information on mental health and wellbeing. This is based on two main variables: scores on the Strengths and Difficulties Questionnaire (SDQ), which measures emotional and behaviour problems, and the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). For more detail on this, please see the Methods section.

Survey purpose

SALSUS informs progress towards Scottish Government policies to reduce the harm from smoking, drinking and drug use among children and young people. The survey series provides local prevalence rates for smoking, drinking and drug use across Alcohol and Drug Partnerships (ADPs), local authorities and NHS Boards. SALSUS has also become a key source of mental health data among young people in Scotland.

Policy background

Having good mental health improves outcomes in health, education and employment. Improving mental health and wellbeing is one of Scotland's public health priorities^[2]. The Scottish Government's Mental Health Strategy 2017-2027^[3] sets out a number of actions aimed at improving mental health, including for children and young people.

The Youth Commission on Mental Health was set up in early 2018. Young people with experiences of mental health services gathered evidence, engaged with other young people and developed recommendations on how child and adolescent mental health services could be improved. Their report was published in May 2019 and the Scottish Government formally responded to these recommendations in November 2019.

The Children and Young People's Mental Health Task Force was also set up in 2018. This provided recommendations to improve provision for children and young people's mental health in Scotland. The Children and Young People's Mental Health and Wellbeing Programme Board was then established to take forward this work.

In the summer of 2018, the Scottish Government undertook a rapid literature review^[4] to explore the apparent worsening of adolescent girls' mental health, as indicated by surveys such as SALSUS. This highlighted several interrelated factors that may contribute to these trends: social media use, disrupted sleep, body image concerns and school-related pressures.

Following from this research the Scottish Government funded the Scottish Youth Parliament and Scottish Children's Parliaments to produce advice on the healthy use of social media, created in partnership with children and young people. This was launched in April 2020. It also set up an Advisory Group on Healthy Body Image, to look at ways of improving support for young people and advice for professionals. It also commissioned a review of evidence^[5] on adolescent screen time, sleep and mental health.

In 2019, the Scottish Government announced a £250 million investment package to deliver dedicated mental health counsellors in schools, extra training for teachers, and an additional 250 school nurses to offer mental health support and advice for young people and their families dealing with mental health issues.

Methods

SALSUS is a self-completion survey administered by teachers in a mixed ability class, under exam conditions. In the past, the survey has been completed on paper, but in 2018 schools were given the choice to complete the survey online or on paper.

A random, nationally representative sample of S2 and S4 pupils in Scottish schools was drawn with classes as the primary sampling unit. All local authority and independent schools in Scotland were eligible for inclusion in the sample, with the exception of special schools.

Fieldwork was completed between October 2018 and April 2019. A total of 12,558 S2 and 10,807 S4 pupils responded (including schools that took part in the Realigning Children's Service Survey^[6]).

The overall response rate was 52% (excluding schools that took part in the Realigning Children's Services Survey and Glasgow state schools, who declined to take part).

Data was weighted by local authority, age, sex, school sector (state/independent), school denomination and by urban/rural classification.

Throughout the report pupils in S2 are referred to as '13 year olds' and S4 pupils are referred to as '15 year olds' for ease. It should be noted that some pupils within these categories may be slightly older or younger.

Some pupils did not answer each question. Where answers are missing, these have been excluded from the analysis and so charts and tables that describe the same population may have varying bases. When differences between estimates are specifically commented on in the report, these differences are statistically significant to the level of 0.05.

Percentages may not add up to 100% due to rounding.

For full details of the methodology, please see the SALSUS 2018 Technical Report^[7]. Also see Appendix A for the full 2018 questionnaire.

Finally, it is important to note that while there are associations between many of the behaviours explored in this report, conclusions about causality cannot be drawn.

Changes to the questionnaire

No alterations were made to the mental health and wellbeing questions for 2018, so they are the same as in the 2015 survey. For further details on other question changes and survey methodology see the SALSUS 2018 Technical Report^[8].

Emotional and behavioural problems and mental wellbeing indicators

Emotional and behavioural problems – Strengths and Difficulties Questionnaire

The 'Strengths and Difficulties Questionnaire' (SDQ) was designed by Robert Goodman (1997)^[9] and is widely used by researchers, clinicians and education professionals. This measure has been included in SALSUS since 2006. The questionnaire comprises 25 items that are grouped into 5 scales, with each scale including 5 questions. The scales are:

• emotional symptoms (5 items)
• conduct problems (5 items)
• hyperactivity/inattention (5 items)
• peer relationship problems (5 items)
• pro-social behaviour (5 items)

Information on how to score the self-completed SDQ was obtained from the website http://www.sdqinfo.org, a site referenced by Goodman et al. For each item in each of the five scales, the value of the responses 'Not true,' 'Somewhat true,' and 'Certainly true' was assigned a value from 0 to 2.

Total scores were calculated for each of the five scales by summing the scores for all items within each scale.

Overall SDQ scores were also calculated as an overall measure of emotional and behavioural problems by summing the scores for emotional problems, conduct problems, hyperactivity and peer problems, but excluding scores for pro-social behaviour. This is because the pro-social scale is a measure of positive behaviour and is quantified in terms of the proportion receiving a normal score rather than a borderline or abnormal one.

The terminology used to describe SDQ scores is borrowed from the original questionnaire designed by Goodman. The terms 'normal', 'borderline,' and 'abnormal' are used to describe scores for each scale. These terms have been used throughout this report to indicate bands of scores for each scale. While the terms may seem out-dated in the context of the language used to describe mental wellbeing in today's language, they have been retained in this report to draw comparisons to previous years.

An alternative method of categorising the SDQ score has been developed in recent years, splitting the overall SDQ score into four groups (close to average, slightly higher, high, and very high) rather than three (normal, borderline, and abnormal). Again, in order to preserve trends, we have continued to use the original groupings.

It is important to note that both methods of categorising the SDQ score are only providing an indication of the levels of emotional and behavioural problems and not being used as a diagnostic tool.

Mental Wellbeing – Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)

The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) was developed by researchers at the Universities of Warwick and Edinburgh, with funding provided by NHS Health Scotland, to enable the measurement of mental wellbeing of adults in the UK^[10]. The scale is validated for use with individuals aged 13 to 74.

Since 2010, SALSUS has included WEMWBS. Developed as a tool for measuring mental wellbeing at a population level, the scale comprises 14 positively worded statements that relate to an individual's state of mental wellbeing (thoughts and feelings). Pupils were asked to indicate how often they have had such thoughts and feelings over the last two weeks. Each statement has a five item scale ranging from '1 - None of the time' to '5 - All of the time'. The lowest possible WEMWBS score is therefore 14 and the highest is 70.