Child and adolescent mental health – a guide for healthcare professionals
June 2006
Prevalence and risk factors of child and adolescent mental health
There is evidence to suggest that the prevalence of childhood mental health problems is gradually increasing. [Notes 36 and 37]. Studies suggest that 20 per cent of children and adolescents have mental health problems at some point,[Notes 1 and 12] and one in ten have a clinically recognisable mental health disorder. A prevalence of 10 per cent of one to 15 year olds would equate to approximately 1.1 million children under the age of 18 who would benefit from specialist services. Up to 45,000 young people suffer from a severe mental health disorder at any one time. [Note 7]
The ONS survey carried out in Great Britain in 2004 covered children aged five to 16, and found that 11 per cent of boys had a mental health disorder, compared with 8 per cent of girls.2 Conduct and hyperkinetic disorders are much more likely in boys than girls, although girls are slightly more liable to suffer from emotional disorders. Older children and young people were found to be more prone to a mental health disorder than younger children. 1.9 per cent of all children had more than one disorder (ie one in five children with a disorder). The sample size for the study was 12,294.
Table 1. Prevalence of mental health disorders in boys and girls in 2004
|
Boys (%) |
Girls (%) |
All 5-16 year olds (%) |
||
Age |
5-10 year olds |
11-16 year olds |
5-10 year olds |
11-16 year olds |
|
Conduct disorder |
6.9 |
8.1 |
2.8 |
5.1 |
5.8 |
|
|
|
|
|
|
Hyperkinetic disorder |
2.7 |
2.4 |
0.4 |
0.4 |
1.5 |
|
|
|
|
|
|
Emotional disorder |
2.2 |
4.0 |
2.5 |
6.1 |
3.7 |
|
|
|
|
|
|
Less common disorders |
2.2 |
1.6 |
0.4 |
1.1 |
1.3 |
|
|
|
|
|
|
Any disorder |
10.2 |
12.6 |
5.1 |
10.3 |
9.6 |
Source: Office for National Statistics (2005) Mental health of children and young people in Great Britain, 2004. London: HMSO.
The ONS survey found that 54 per cent of children with an emotional disorder were girls and that 62 per cent were aged 11-16. Children with an emotional disorder were more likely to come from a single parent family (31 %, compared to 15 % for children with no emotional disorder), and 54 per cent lived in households with incomes under £300 per week. The survey also found that children with an emotional disorder were more likely to suffer poor physical health (23 %, compared to 5 % of children with no disorder). There were no significant differences between ethnic groups. [Note 2]. The majority of children (86 %) with hyperkinetic disorder were boys, and almost all were white (97 %). They were more likely to live in households with low income (52 % lived in households with less that £300 per week), and have parents with no educational qualifications (36 % compared to 21 % of children with no disorder). [Note 2].
As these figures suggest, research has shown that different factors affect the prevalence of mental health problems in children and young people, with the socio-economic situation playing a major part. [Note 38]. The findings of the 2004 ONS survey were compared to a previous survey conducted in 1999, which showed very similar results. The 2004 survey is discussed here. It found that the prevalence of mental health problems was higher among children in families where neither parent worked (20 %) compared to those in which both parents worked (8 %), and one parent worked (9 %). Sixteen per cent of children from families with a weekly household income of under £100 suffered from mental health problems, compared to 5 per cent with a weekly household income of more than £600.2 Using the National Statistics Socio-economic Class (NS-SEC), it was shown that 13 per cent of children with parents from semi-routine and 15 per cent of those with parents from routine occupational groups suffered from a disorder, compared to 4 per cent of children with parents in higher professional groups.
|
The link between childhood mental health problems and familial affluence is again highlighted by type of accommodation. Children living in rented accommodation, either social sector (17 %) or private sector (14 %), were twice as likely to suffer from a mental health problem than those in owned accommodation (7 %). [Note 2] Similarly, there is evidence to show that homelessness can lead to poor mental health and lower educational attainment. [Note 39]. Section on Health inequalities for further discussion on the links between mental health problems and deprivation.
Educational qualifications of the parent, especially the mother, have a strong impact on prevalence of mental health problems. The ONS survey showed a rate of 17 per cent among children whose parent had no educational qualification, as opposed to 4 per cent among those with parents educated to degree level. [Note 2].
Family make-up can also impact on the mental health of children and young people. Prevalence rates of mental health problems were higher in children from single parent families (16 %) compared to married couple families (7 %). Nearly one fifth (18 %) of boys living in single parent families suffered from a mental health problem, as opposed to 13 per cent of girls. Reconstituted families, ie those where stepchildren are present, also increased the prevalence of mental health problem: 14 per cent compared to 9 per cent without stepchildren. [Note 2].
There are a large number of risk factors that increase the vulnerability of children and young people to mental health problems. As outlined above, deprivation presents an important risk. Other factors that increase risk include poor educational and employment opportunities, enduring poor physical health, poor peer and family relationships, witnessing domestic violence and having a parent suffering from mental ill health or misusing substances. Children who have been physically and sexually abused are at particular risk. Asylum seeker and refugee children have been shown to have consistently higher levels of mental health problems, including post-traumatic stress, anxiety and depression. This group is discussed further in the Health inequalities section.
Looked after children (ie those brought up in local authority care) are particularly at risk of poor mental health. An ONS report, The mental health of young people looked after by local authorities in England (2003) found that in England, 45 per cent of looked after five to 17 year olds had a mental health disorder, compared to 10 per cent from private households. [Note 40]. In Wales, 49 per cent of five to 17 year olds in care had some form of mental health disorder, [Note 41] and in Scotland, the figure was 45 per cent. [Note 42]. Looked after children are discussed in more detail in the Health inequalities section. Young people in the youth justice system are another group among whom there is a high incidence of mental health problems. Young offenders are discussed in more detail in the Health inequalities section.
The ONS survey found no differences between metropolitan and non-metropolitan areas in England. However, closer examination identify variations between areas of wealth and deprivation, as would be expected. There is no significant variation between England, Scotland and Wales.
ONS analysis of the survey data on prevalence of mental health problems among children from black and minority ethnic (BME) groups was difficult. The sample sizes for these groups in the survey were small, and there were also language barriers where English was not a first language. The survey found that Indian children had a low reported rate of mental health problems (3 % compared with 7-10 %for other groups), and that all non-white groups had a low rate of hyperkinetic disorder. [Note 2] Other evidence shows that BME groups are more likely to suffer inequalities in accessing, using and achieving positive outcomes in mental healthcare. [Note 36]. This is discussed in the Health inequalities section.
The ONS surveys do not extend to Northern Ireland, and there has been little in the way of examination of the prevalence of mental health problems there. However, Northern Ireland has a higher proportion of children (27 % of the population are under 18, compared to 22 % in England), and higher levels of socio-economic deprivation. It has also been subjected to 30 years of civil conflict, and there is a higher prevalence of adult mental health problems than in the rest of the UK. It is, therefore, probable that the prevalence of childhood problems will be as great, if not greater than, the rest of Britain. [Note 43].