Elsevier

Social Science & Medicine

Volume 71, Issue 10, November 2010, Pages 1819-1830
Social Science & Medicine

Can we explain increases in young people’s psychological distress over time?

https://doi.org/10.1016/j.socscimed.2010.08.012Get rights and content

Abstract

This paper aims to explain previously described increases in self-reported psychological distress between 1987 and 2006 among samples identical in respect of age (15 years), school year and geographical location (West of Scotland). Such increases might be explained by changes in exposure (changes in levels of risk or protective factors) and/or by changes in vulnerability (changes in the relationship between risk/protective factors and psychological distress). Key areas of social change over this time period allow identification of potential explanatory factors, categorised as economic, family, educational, values and lifestyle and represented by variables common to each study. Psychological distress was measured via the 12-item General Health Questionnaire, Likert scored. Analyses were conducted on those with complete data on all variables (N = 3276 of 3929), and separately for males and females. Between 1987 and 2006, levels of almost every potential explanatory factor changed in line with general societal trends. Associations between explanatory factors and GHQ tended to be stronger among females, and at the later date. The strongest associations were with worries, arguments with parents, and, at the later date, school disengagement. The factors which best accounted for the increase in mean GHQ between 1987 and 2006 were arguments with parents, school disengagement, worry about school and, for females, worry about family relationships, reflecting both increasing exposure and vulnerability to these risk factors. A number of limitations to our analysis can be identified. However, our results reinforce the conclusions of others in highlighting the role of family and educational factors as plausible explanations for increases in young people’s psychological distress.

Introduction

Substantial increases have been identified in a number of psychosocial disorders among young people in most Western countries since the Second World War (Rutter and Smith, 1995a, Fombonne, 1998). However, the findings are not entirely consistent, trends are complex (Maughan, Iervolino, & Collishaw, 2005) and methodological problems include a lack of repeat cross-sectional surveys using the same measure on socially and geographically comparable groups of young people (Angold & Costello, 2001). Using data from two studies with samples identical in respect of age (15 years), school year and geographical location, we showed marked increases in self-report ‘psychological distress’ (GHQ-12 ‘caseness’), among females between 1987 and 2006 and smaller, but still highly significant increases among males (Sweeting, Young, & West, 2009). The focus of the present paper is on whether these increases in psychological distress can be explained by a range of factors represented by variables common to each study.

We begin our Introduction with a discussion of methodological approaches to explaining increases in mental health problems. This is followed by brief reviews of the literature on time trends in key areas of social change (economic, family, education, values and lifestyle), and associations between these factors and the mental health of young people. The focus, wherever possible, is on the period covered by our own studies (1987–2006); the vast literatures in each of these areas mean that our reviews cannot be comprehensive. However, they demonstrate a broad background of social change against which our own analysis of 15 year olds in 1987 and 2006 is set.

The best candidates as explanatory factors are those which have been shown to be related to young people’s mental health at an individual level (Rutter, 1995). Increasing mental health problems could be due to the emergence of new risk factors or to increases in the frequency of, or vulnerability to, existing risk factors (Caprara & Rutter, 1995). Alternatively, they may be due to the disappearance or reduction of protective factors. These mechanisms can be thought of in terms of exposure (changes in levels of risk/protective factors) and vulnerability (which suggests that even if levels of a risk factor remain the same, its relationship with mental health may change over time).

One method which has been used to explore whether time trends in mental health can be attributed to particular social changes is to examine relationships between aggregate data over time as, for example, in studies which relate national trends in young people’s mental health to trends in the labour market for young people (Lager & Bremberg, 2009). However, since aggregate-level analyses must be regarded with caution (the ecological fallacy) (Piantadosi, Byar, & Green, 1988), a better method is to combine datasets which contain comparable measures of both mental health and candidate explanatory factors and assess whether changes in the former can be ‘explained’ (in a statistical sense) by changes in the latter. The scarcity of datasets which can be combined in this way means that almost no such analysis has been conducted. One which did combined data from 16 year olds obtained from national UK studies in 1974, 1986 and 1999. An increase in conduct problems over time was only partially explained by the increasing proportions of adolescents living in lone and reconstituted households and in relatively low income families, while the lower proportion living in large families should have decreased conduct problems. Although each factor was associated with conduct problems within each cohort, ‘they did little to account for differences in levels of conduct problems between cohorts’ (Collishaw, Goodman, Pickles, & Maughan, 2007, p. 2586).

Time trends in key areas of social change, and associations between these factors and the mental health of young people reviewed below, allow us to hypothesise about the contribution these changes may have made to trends in young people’s mental health.

This potential explanation is based on evidence of differences in mental health according to socioeconomic status or factors such as unemployment. However, overall economic conditions within the UK improved between 1987 and 2006, which should, if the relationship is with absolute disadvantage, have led to reduced youth distress (Smith & Rutter, 1995). If the mechanism is one associated with relative disadvantage (Wilkinson, 1996), there has been relatively little change in income inequality since around 1990 (UK National Equality Panel et al., 2010). Further, and contrasting with more severe ‘mental disorder’ (Meltzer, Gatwood, Goodman, & Ford, 2000), there is actually little or no evidence of socioeconomic inequalities in minor psychological morbidity in youth. This is seen in several studies focussing on the GHQ (e.g., McMunn, Bost, Nazroo, & Primatesta, 1998) including our own (West et al., 1990, West and Sweeting, 2003), and other measures of ‘well-being’, psychosocial health, psychosomatic or malaise symptoms (Modin and Ostberg, 2007, Piko and Fitzpatrick, 2001, West and Sweeting, 2004).

Since the 1960s the modal nuclear family of breadwinner father, stay-at-home mother and biologically related children has diversified (Hess, 1995). Focusing on the period covered by the present study, the employment rate among 16–59 year old females rose from 64% in 1988 to 70% in 2006 (Office for National Statistics, 2001, Office for National Statistics, 2006); the norm in contemporary two parent families is for both to work (Green & Parker, 2006). In tandem, the proportion of families with dependent children headed by a lone parent doubled from 13% in 1987 to 25% in 2006 (National Statistics, 2009, OPCS, 1989). Maternal employment does not appear to have an adverse impact on adolescent well-being, indeed, it may have a positive effect on some outcomes (Aube, Fleury, & Smetana, 2000). In respect of family structure, reviews suggest that children from divorced families tend to have poorer psychological adjustment, self-concept and social competence than those of married parents, but the effect sizes are small and, for some, parental separation or divorce may be positive (Amato, 2000); studies of father absence in adolescence also show mixed effects (East, Jackson, & O’Brien, 2006).

Generally, the evidence is that differences by family structure tend to be accounted for, and/or dwarfed by those in respect of family dynamics (Demo and Acock, 1998, McFarlane et al., 1995). For example, a large study of English 10–15 year olds found that while family structure explained less than 2% of the variation in subjective well-being, responses to the statement ‘my family gets along well together’ accounted for over 20% (Rees, Bradshaw, Goswami, & Keung, 2010). Sparse data mean time trends in family dynamics are harder to determine. However, a review of UK-based studies suggests increases in parental monitoring and parental expectations of good behaviour between 1986 and 2006 and in time spent caring for children between the 1960s and 1990s. Set against this, the proportion of teenagers eating family meals fell, while parental self-reported distress increased (Nuffield Foundation, 2009). Studies of trends in parental care and control, known to be key to adolescent mental health (Rigby, Slee, & Martin, 2007), are almost non-existent, although one review paper of trends across nations suggests a general shift towards more authoritative styles (Larson, Wilson, Bradford Brown, Firstenberg, & Verma, 2002), generally associated with positive outcomes, at least in Western societies (Rigby et al., 2007).

It has been argued that over the past 30–40 years, the UK, particularly England, has seen greater use of assessment to try and raise educational standards than anywhere else in the world (Torrance, 2003). Academic work generates worry for schoolchildren of all ages, particularly secondary pupils facing national examinations (Putwain, 2007). In a study which identified 10 dimensions of adolescent stress, four were school-related (stress of school performance, attendance, teacher interaction and school/leisure conflict). The first of these increased significantly with age and was higher among females; all were significantly associated with psychological distress (Byrne, Davenport, & Mazanov, 2007). Although females have out-performed males at school in most Western countries over the last 20 years or so (Johnson, 2008), they are more likely to underestimate their academic competence (Cole, Martin, Peeke, Seroczynski, & Fier, 1999) and display more anxiety and depression before exams (West & Sweeting, 2003).

A heightened emphasis on achievement in some schools may marginalise and demotivate pupils identified as unlikely to succeed (Fletcher, Bonell, & Rhodes, 2009); adolescents who perceive school as competitive or unfair are more likely to withdraw (Roeser, Eccles, & Sameroff, 2000). School disengagement has been associated with negative psychosocial and behavioural pupil outcomes (Van Ryzin et al., 2009, West et al., 2004). Between 1990 and 2006, the proportion of Scottish female secondary pupils who liked school a lot dropped from 33% to 29%, while no change was seen for males (23%–22%) (Currie, Levin, Todd, & HBSC National Team, 2008).

It has been suggested that the materialism and individualism associated with modern Western cultures are hazardous for mental health (Eckersley, 2006). This issue forms the basis of the UK report ‘A Good Childhood’, which contrasts the many ways in which ‘our children have never lived so well’ with widespread unease about their experience and concerns about their well-being (Layard & Dunn, 2009).

In respect of values, a series of meta-analyses of US studies of children and young people conducted at different times over the latter half of the 20th century highlighted increases in self-reported anxiety, correlations with broader indices suggesting a causal role for decreased social connectedness and increased environmental dangers (e.g., crime rates) (Twenge, 2000). Over this period, locus of control scores became more external, consistent with increases in cynicism and individualism (Twenge, Zhang, & Im, 2004). In 2003 only 24% of UK 12–19 year olds believed that most people could be trusted (Park, Phillips, Johnson, & National Centre for Social Research, 2004). Religious commitment and participation represent one aspect of ‘belonging to something bigger than oneself’ (Layard & Dunn, 2009, p. 84). Both have been associated with subjective well-being, the effects of the latter appearing to reflect more than positive effects of social interaction (La Barbera & Gurhan, 1997). Churchgoing has been declining since at least the mid 19th century, and opinion poll evidence also suggests declining religious belief over recent decades (Voas & Crockett, 2005). Between 1994 and 2003, the proportion of British 12–19 year olds describing themselves as belonging to a religion dropped from 45% to 35% (Park et al., 2004).

While social trust and religious commitment declined, the spending power and commercial involvement of children and young people increased (Schor, 2004, West et al., 2006). Several studies, conducted since 1990, have suggested that materialistic values are related to lowered well-being and life satisfaction (Burroughs and Rindfleisch, 2002, Richins and Dawson, 1992). The commercialisation of childhood has been associated with a range of negative effects (Kramer, 2006). A survey of US 10–13 year olds found relationships between consumer involvement and psychosomatic symptoms, depression, anxiety and (low) self-esteem (Schor, 2004). Materialism has been shown to be related to parent–child conflict and disappointment after the refusal of purchase requests among Dutch 8–12 year olds (Buijzen & Valkenburg, 2003) and to lower opinion of parents and parent–child conflict in UK 9–13 year olds (National Consumer Council, Nairn, Ormrod, & Bottomley, 2007). It has also been linked with emotional/behavioural problems in British 11–19 year olds (Flouri, 2002) and to reduced life satisfaction in Hungarian 14–21 year olds (Piko, 2006), while promoting higher self-esteem appears to reduce materialism among children and adolescents (Chaplin & John, 2007).

A related aspect of consumerism refers to the construction of desirable identities, particularly related to attractiveness. These are promoted by increasingly pervasive media (Monro & Huon, 2005) and felt more strongly by females (Knauss, Paxton, & Alsaker, 2007). However, evidence on the relationship between adolescent mental health and one aspect of appearance, obesity, is mixed, psychological distress appearing more strongly associated with concern about weight and shape, regardless of BMI (Allen et al., 2006, Jansen et al., 2008). Given our focus on time trends, the question is whether such concerns have increased or decreased. While it has been suggested that increasing obesity prevalence may have reduced its stigmatisation (Chang & Christakis, 2002), findings are inconsistent (Sweeting, West, & Young, 2008). Among the sparse research addressing changes in satisfaction with appearance more generally, a large Norwegian study of 13–19 year olds found a polarisation between 1992 and 2002, with increasing proportions very dissatisfied and very satisfied (Storvoll, Strandbu, & Wichstrom, 2005).

The second half of the 20th century also saw the emergence of teenagers as a distinct social group with their own cultural territory (Bennett, 2005), and, paralleling this, the rise of youth subcultures (Miles, 2000). Although subcultural affiliation as represented by group membership or music preference has more often been associated with adverse health behaviours, particularly substance use (Forsyth et al., 1997, Mulder et al., 2009), there is some evidence of relationships with psychological distress. Thus, Goths have been described as a ‘psychosocial high-risk culture’ (Rutledge, Rimer, & Scott, 2008) associated with depression and, among one of our own cohorts, self-harm and suicide (Young, Sweeting, & West, 2006). However, positive effects have also been acknowledged, including the solidarity and collective identity associated with membership of certain subcultural groups, and the use of music to overcome low mood (Bennett, 2005, Kavanaugh and Anderson, 2008).

Young people’s ‘lifestyles’ have changed radically since the mid 20th century. In particular, they have become more leisure/entertainment oriented. One expression of this has been the involvement of young people as (majority) consumers of the ‘night-time’ (bars, pubs, clubs and music venues) which has developed, within the UK at least, since the 1970s (Hollands & Chatterton, 2002); (Chatterton & Hollands, 2002). The ‘going-out’ scene, which, by the end of the 20th century, represented normative behaviour (Eggerton, Williams, & Parker, 2002), begins at a younger age than that of legal access to UK licensed premises, recently encouraged by alcohol-free under-18s events. For the vast majority, the link between ‘going-out’ and intoxication means there are associated risks such as violence and accidents as well as more general physical and psychological substance-related effects (Eggerton et al., 2002).

Another significant aspect of changing youth lifestyles is their increasing involvement with electronic media, involving massive increases in computer and video game use. Computer games have also evolved, the current generation allowing more graphic depictions of violence, and having the ability to connect players virtually (Smyth, 2007). Studies of the association between computer games and psychological well-being have largely focused on aggression, addiction and social isolation. Although the consensus appears to be that, at least in moderation, game-playing has few effects (Griffiths, 2005), there is some evidence that violent games may be related to aggressive and/or antisocial behaviour (Porter & Starcevic, 2007). However, there is no evidence for associations between gaming and the development of depression (Primack, Swanier, Georgiopoulos, Land, & Fine, 2009) or social isolation (Cummings & Vandewater, 2007) among representative adolescent samples. Indeed, gaming can often be a social experience for adolescents (Lenhart et al., 2008) and the advent of player networking facilities means that it may now be associated with large social groupings (Smyth, 2007).

Just as it is possible that changes in economic conditions, family life or educational factors might explain time trends in young people’s mental health, so also might changes in values and lifestyles. The bulk of the evidence cited above suggests that reduced social trust and religious commitment coupled with increased commercial involvement, focus on appearance, subcultural affiliation, the ‘going-out’ scene and electronic media might have contributed to increasing mental health problems.

The present study is set against this broad background of social change. It examines whether the increases in psychological distress observed among 15 year olds between 1987 and 2006 can be explained by a range of factors represented by variables common to each study. These can be categorised as economic (no working parent, shared bedroom, worry about own unemployment), family (not with both birth parents, arguments with parental figures, family outings, worry about family relationships), education (school disengagement, worry about school), values and lifestyle (religious attendance, youth subculture, disco/club attendance, computer game play, spending power, obesity, worry about weight, worry about appearance). These represent both ‘objective’ factors (as reported by the young people or, in some cases, their parents), together with worries, which are clearly ‘subjective’. While it is possible that any relations between ‘objective’ factors and psychological distress result from that distress, this is much more likely in the case of worries; indeed worrying is one component of our measure of distress. However, they are included because of the public perception that worries, particularly school- and appearance-related, have increased among adolescents over the past couple of decades and mirror wider changes in society.

Our choice of variables was constrained by those available to us. Ideally, we might, for example, have included family income, a measure of parental care and control, or responses to a consumer involvement scale. Instead, we have had to select measures available in both our 1987 and 2006 datasets which best represent aspects of social change. The studies themselves, particularly the earlier one, were initiated with a broad health and lifestyle focus, rather than a consideration of time trends. They are unusual in that they have samples which are equivalent in terms of geographical location, age and educational status, and a wide range of broadly comparable variables.

Section snippets

Methods

Both samples included 15-year olds in their final year of (Scottish) statutory education (S4), resident in the Central Clydeside Conurbation, centred around Glasgow. They comprised the ‘West of Scotland Twenty-07 Study: Health in the Community’ (‘Twenty-07’ – (Benzeval et al., 2008)) youth cohort and ‘Peers and Levels of Stress’ (‘PaLS’ – (Sweeting, Young, & West, 2008)).

Twenty-07 is a longitudinal study of three age cohorts, the youngest (‘youth’) cohort being aged 15 when first surveyed in

Measures

Psychological distress was measured via the 12-item General Health Questionnaire (GHQ-12) (Goldberg & Williams, 1988), which has been validated for use with both older (age 17; Banks, 1983) and younger (ages 11–15 (Tait, French, & Hulse, 2003)) adolescents. The GHQ was designed as a measure of state, focussing on inability to carry out normal functions and the emergence of distressing symptoms. Each item includes four answer options and can be scored as a Likert scale (0–3, resulting range

Analyses

All analyses were conducted on those with complete data on all variables, so reducing the sample sizes to 649 (1987) and 2627 (2006). There were no sex differences in respect of those included or excluded in the analyses, but those included were more likely to have working parents (90% versus 83%, p < .001) and had lower GHQ Likert scores (mean 10.6 versus 11.4, p < .001). Probabilistic weights have been constructed to compensate for socio-demographic differences between responders and

Results

Basic distributions of GHQ ‘caseness’ and all potential explanatory variables for males and females at each date, with the significance of the 1987–2006 differences are shown in Table 1, Table 2 (categorical variables – numbers, percentages and significance of chi-square) and 2 (continuous variables – means, SDs, numbers and significance of F). As Table 2 shows, mean GHQ score increased by 0.98 points (8.49–9.47) among males and by 2.75 (9.66–12.41) among females; the spread of scores was also

Discussion

This paper uses data on 15 year olds in 1987 and 2006 in an attempt to explain previously demonstrated increases in psychological distress (Sweeting et al., 2009) over this time period. Such increases might be explained by changes in exposure and/or by changes in vulnerability. A range of potential explanatory variables, chosen to represent aspects of social change (categorised as economic, family, educational, values and lifestyle factors) and common to each dataset were examined.

With only one

Acknowledgements

This work was funded by the UK Medical Research Council as part of the Youth and Health (WBS U.1300.00.007) and Gender and Health WBS (U.1300.00.004) programmes at the Social and Public Health Sciences Unit. The authors would like to thank Sally Macintyre and Kate Hunt for comments on an earlier version. Acknowledgements are also due to the young people, nurse interviewers, schools, and all those from the MRC Social and Public Health Sciences Unit involved in the studies described here.

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