Mental Health & Wellbeing of Students in Leeds, Grenville & Lanark (2009)

Transcription

1 Mental Health & Wellbeing of Students in Leeds, Grenville & Lanark (2009) Highlights: 92.8% of students felt close to the people in their schools. 86.5% rated their physical health as being good to excellent. 27.8% of students selfreported being overweight or obese. 72.0% of students had seen a health care professional about their physical health. 35.3% of students report being bullied. 46.2% of students report some type of gambling activity. Contents: Student Demographics 2 School Climate 3 Physical Health 4 Health Care Utilization 9 Mental & Emotional Health Delinquent Behaviour & Bullying Gambling Activity 19 About the Data 21 References 21 Overview of Student Mental Health & Wellbeing in LGL (2009) This surveillance report on student mental health and wellbeing contains data from both primary (Gr. 7-8) and secondary (Gr. 9-12) schools situated in Leeds, Grenville and Lanark counties (LGL). The data was gathered in May of 2009 from a total of 16 randomly selected schools (872 students). This report summarizes current mental and physical health and risk behaviour indicators and compares them to Ontario s overall student population. A confidence interval (CI) is a range of values that is normally used to describe the precision around a percentage or rate determined from sampled data. CIs used to describe health data are usually calculated with a stated probability of 95%, and we say that there is a 95% chance that the CI covers the value you would obtain if you surveyed the entire population of interest. If two percentages or rates from the same overall population have CIs that overlap then they are said to be not statistically significantly different. However, if two CIs do not overlap, a comparable statistical test would usually indicate a statistically significant difference. CIs can allow for the quick determination of these differences if they exist. For example: In the following fictitious data, the percentage for men: 41.4% (95% C.I.: 39.5, 43.5) The report contains analysis of the 12-month period prior to the survey as well as from the beginning of the school year (September). Data is presented overall, by sex, school type (primary vs. secondary) and grade where numbers of respondents permit. A more comprehensive analysis of Ontario-wide student mental health and wellbeing can be found in the 2009 Ontario Student Drug Use & Health Survey (OSDUHS) report 1. Interpreting the Results using Confidence Intervals is significantly higher than women: 33.4% (95% C.I.: 30.2, 36.6) as the CIs do not overlap. Small numbers of respondents to a question tend to produce wide variability that renders them too unstable to use as a reliable estimate. Estimates with sampling variability greater than what has been determined acceptable by Statistics Canada 2 were either reported with a cautionary note indicated by an asterisk (*) or suppressed (see page 21 for more details about the OSDUHS survey).

2 Student Demographics This report represents a weighted sample of 13,791 students from LGL in grades 7 to 12. This total breaks down into the Upper Canada District School Board (7993 students) and the Catholic District School Board of Eastern Ontario (5798 students). Of the sample, 51.8% of respondents were male and 48.2% female. The respondents were distributed fairly equally between grades (Figure 1). In terms of language spoken at home, 93.1% of students report speaking English, 4.2% English and/or French and 2.6% English and other language or other language only at home. Figure 1: Distribution of sampling of primary and secondary school respondents. When asked what marks they usually got in school, 91.3% stated they usually received a B or above. This coincides with the 99.0% who stated that they would most likely graduate from high school. A total of 96.9% of students responded they were born in Canada and 82.8% responded that they live in one home only (not split between homes). 91.1% of students responded they lived with their natural mother in their main home. (Figure 2). Figure 2: Which parent student lives with in main home. Page 2

3 LGL students were asked to rate their level of agreement, ranging from strongly agree to strongly disagree, with several statements about their schools from an academic and safety standpoint. The questions asked were: I feel close to people at this school. I feel like I am a part of this school. Most teachers in my school are excellent. Most classes offered at my school are challenging. I feel safe at my school. School Attachment The majority of respondents (92.8%) felt they were close to people at their school with females (93.0%) and males (92.5%) responding similarly. 89.9% of students also responded they felt like they were a part of their school as well, with females (89.1%) and males (90.6%) providing similar responses. Academic Rating Overall, 84.8% of students responded that most teachers in their schools were excellent with 88.2% of females and 81.4 % of males responding similarly. 78.1% of students felt most of the classes offered at their schools were challenging, with females (78.0%) and males (78.4%) responding similarly. School Safety Mental Health & Wellbeing of Students in Leeds, Grenville & Lanark (2009) School Climate The school safety question was asked as follows: At school, how worried are you that someone will harm you, threaten you, or take something from you?. The majority of students (88.9%) reported they feel safe at school. Males and females responded similarly. Students from LGL and Ontario overall both responded similarly. However, more primary school students responded they didn t feel safe at school (14.3%) than secondary school students (9.7%) and the difference was statistically significant (Figure 3). Figure 3: Percentage reporting they were somewhat worried or very worried about being harmed or threatened at school. Page 3

4 Physical Health LGL students were asked to rate their level of physical health and provide measures for the calculation of their body mass index (BMI). Students were also asked to rate their levels of physical activity, screen time and give their impressions of their own weight. The questions asked were: How would you rate your physical health? On how many of the last 7-days were you physically active for at least 60-minutes each day? In the last 7-days, how many hours per day, on average, did you spend watching TV/movies, playing video/computer games, on the computer chatting, ing or surfing the internet? Do you think of yourself as being too thin, about the right weight or too fat? Self-Rated Physical Health The response option categories for the self-rated physical health question were: poor, fair, good, very good, and excellent. The categories for poor and fair were combined as were the very good and excellent categories. About half of respondents rated their physical health as very good to excellent 51.3% (95% C.I: 47.0, 55.6). Females were significantly more likely at 18.0 (95% C.I.: 14.7, 21.9) than males at 9.2% (95% C.I.: 6.3, 13.4) to self-report their physical health as being fair to poor. Respondents from schools located in LGL reported levels of fair to poor physical health at 13.5% (95% C.I.: 11.6, 15.6) similar with Ontario overall at 14.5% (95% C.I.: 13.3, 15.8). Students in Secondary schools reported rates of fair to poor physical health at 15.9% (95% C.I.: 14.3, 17.5). This rate is statistically significantly higher than those in primary schools at 8.0 (95% C.I.: 4.0, 12.0). As well, there was a well defined trend in increasing levels of fair to poor physical health associated with grade level with students in grade 8 reporting 9.2% (95% C.I.: 4.4, 18.5) fair to poor physical health versus students in grade 12 reporting 20.4% (95% C.I.: 17.2, 24.2) fair to poor levels of physical health (Figure 4). The rate for grade 7 was not reportable. Figure 4: Percentage reporting levels of physical health that are fair to poor by demographic. Page 4

5 Self-Rated Physical Activity Mental Health & Wellbeing of Students in Leeds, Grenville & Lanark (2009) Physical Health (cont.) Students were asked to report about their levels of physical activity for the 7-days prior to the survey in terms of activity of at least 60-minutes per day. Examples of physical activity given were those that increased heart rate and breathing rates (e.g. brisk walking, running, rollerblading, biking, dancing, skateboarding, swimming, soccer, football). Exactly 26.2% (95% C.I.: 21.1, 32.2) of respondents reported being active for at least 60-minutes daily 7-days per week. However, a full 33.5% of students reported being active 3-days of the week or less (Figure 5). Males were significantly more likely than females to report their physical activity levels of 7-days per week with 33.6% (95% C.I.: 28.9, 38.6) of males versus 18.5% (95% C.I.: 12.9, 25.7) of females (Figure 6). A total of 56.7% of primary school students reported at least 5 or more days of physical activity compared to 51.1% of students in secondary schools (graphic not shown). Figure 5: Percentage reporting levels of daily physical activity of at least 60-minutes. Figure 6: Percentage reporting levels of daily physical activity of at least 60-minutes by sex. Page 5

6 Physical Health (cont.) Sedentary Behaviour (Screen Time) Students were asked to report about the usual amount of time they spent in front of a computer or television for the 7-days prior to the survey. A total of 6.3% (95% C.I.: 4.4, 9.0) of respondents reported spending 7 or more hours of screen time per day. A full 18.3% of students reported at least 5 or more hours per day of screen time (Figure 7). The patterns of screen time between males and females were similar with only slight differences between daily screen time categories. However, none of the differences were statistically significant (Figure 8). The differences in screen time between primary and secondary schools students were striking. A total of 11.8% of primary school students reported at least 5 or more hours per day of screen time compared to 21.1% of students in secondary schools. This difference was statistically significant (graphic not shown). Figure 7: Percentage reporting levels of daily screen time. Figure 8: Percentage reporting levels of daily screen time by sex. Page 6

7 Physical Health (cont.) Overweight/Obese (Body Mass Index) Students were asked to report their current height and weight so that their BMI could be calculated. The age and sex cut-off points as detailed by Cole et al. 3 were used. Among the total sample, 21.9% (95% C.I.: 18.3, 26.1) were considered to be overweight and a further 5.9% (95% C.I.: 4.5, 7.8) were considered to be obese (Figure 9). It should be noted that 4.9% (95% C.I.: 4.2, 5.7) of potential respondents did not supply height or weight information. Rates of overweight and obese amongst all students in LGL was 27.9% (95% C.I.: 24.2, 31.8) which was not significantly higher than Ontario overall. Overweight and obese was calculated as being higher amongst males at 32.9% (95% C.I.: 26.2, 40.4) compared to females at 22.6% (95% C.I.: 18.3, 27.6). These differences were not statistically significant. Higher rates of overweight or obese were also observed in secondary compared to primary schools. The trend for overweight and obesity was fairly consistent throughout secondary school (Figure 10). Figure 9: Levels of BMI for normal weight, overweight and obese students in LGL. Figure 10: Levels of BMI for combined overweight and obese students in LGL by demographic. Page 7

8 Physical Health (cont.) Overweight/Obese (Body Mass Index) Students were asked to report whether they thought they were underweight, overweight or the right weight. Significantly more females reported that they were overweight at 30.5% (95% C.I.: 21.3, 41.7) compared to males at 13.5% (95% C.I.: 10.3, 17.5) (Figure 11). Similar rates of weight perception were reported between primary and secondary schools, with 69.3% (95% C.I.: 62.8, 75.2) of primary school versus 72.7% (95% C.I.: 62.2, 81.1) of secondary school students reporting being about the right weight (Figure 12). Figure 11: Weight perception amongst LGL students by sex. Figure 12: Weight perception amongst LGL students by school type. Page 8

9 Health Care Utilization LGL students were asked to rate their frequency of health care utilization and times being injured that required medical treatment. Students were also asked if they had seen a medical professional for emotional or mental health reasons in the 12-months prior to the survey. The questions asked were: In the past 12-months how many times have you seen a doctor about your physical health or for a check-up? In the past 12-months, how many times were you hurt or injured, and had to be treated by a doctor or nurse? In the past 12-months, how often have you seen a doctor, nurse or counselor about your emotional or mental health? Physical Health Doctor Visits Overall, 72% of students reported seeing a medical professional for a physical check-up in the 12-months prior to the survey at least one time. 29.8% (95% C.I.: 23.7, 36.7) reported seeing a medical professional once. However, 28.0% (95% C.I.: 20.2, 37.4) reported that they did not have a physical check-up in the 12-months prior to the survey (Figure 13). Figure 13: Percentage reporting frequency of physical health check-up by a health professional. Page 9

10 Health Care Utilization (cont.) Physical Health Doctor Visits (cont.) Rates of LGL students seeing a health professional for a check-up were higher in LGL than Ontario overall but the difference was not statistically significant. Visits were higher for females 74.3% (95% C.I.: 64.6, 82.0) compared to males at 69.9% (95% C.I.: 58.0, 79.7) although the difference was not statistically significant. Higher rates were also observed for secondary school students 76.0% (95% C.I.: 63.1, 85.4) compared to primary school at 63.5% (95% C.I.: 48.3, 76.4). The trend in rates of check-up visits associated with grade level was not well defined ranging from 61.3% (95% C.I.: 37.3, 80.9) for students in grade 8 reporting a check-up in the past 12-months to 82.2% (95% C.I.: 55.3, 90.5) in grade 12 (Figure 14). Figure 14: Percentage reporting having a physical check-up in past 12-months by demographic. Page 10

11 Health Care Utilization (cont.) Treated for a Physical Injury Overall, 51.9% of students reported seeing a medical professional due to a physical injury in the 12-months prior to the survey. Of these, 27.8% (95% C.I.: 23.4, 32.7) reported only one visit. However, 11.3% (95% C.I.: 8.1, 15.4) reported seeing a medical professional three times or more (Figure 15). Rates of physical injury treatment amongst all students in LGL was 51.9% (95% C.I.: 46.9, 56.8) which was statistically significantly lower than Ontario overall. Rates of physical injury treatment were calculated as being only slightly higher amongst males at 52.7% (95% C.I.: 44.5, 60.8) compared to females at 50.9% (95% C.I.: 46.2, 55.5). This difference was not statistically significant. Higher rates of physical injury treatment were also observed in secondary schools compared to primary (Figure 16). The trend for physical injury treatment associated with grade level was not well defined ranging from 47.1% (95% C.I.: 33.6, 61.1) of students in grade 8 to 57.7% (95% C.I.: 38.8, 74.3) for students in grade 10 (Figure 16). Figure 15: Percentage reporting having been treated for a physical injury in past 12-months. Figure 16: Percentage reporting having been treated for a physical injury in past 12-months by demographic. Page 11

12 Health Care Utilization (cont.) Mental Health Professional Visit Overall, 79.8% (95% C.I.: 74.0, 84.6) of students reported that they did not seek the help of a medical professional for either emotional or mental health reasons in the 12-months prior to the survey. Of the 20.2% who did, 7.2% (95% C.I.: 4.3, 11.8) reported one visit. A further 7.7% (95% C.I.: 5.4, 10.9) reported seeing a medical professional three times or more times (Figure 17). Rates of emotional or mental health treatment amongst all students in LGL was 20.2% (95% C.I.: 15.4, 26.0) which was lower than Ontario overall. Rates were also lower for both males compared to females and secondary school students compared to primary, although the differences were not statistically significant (Figure 18). The trend for emotional or mental health treatment associated with grade level was fairly flat, with the exception of higher rates for grade 7 students (Figure 18). Figure 17: Percentage reporting having been treated for an emotional or mental health reason in past 12-months. Figure 18: Percentage reporting having been treated for an emotional or mental health reason in past 12-months by demographic. Page 12

13 Mental & Emotional Health LGL students were asked to rate their level of mental and emotional health. Students were also asked to rate their levels of self esteem and depression. A series of general health screening questions were also asked to determine levels of psychological distress related to depression, anxiety and difficulty with social functioning. The questions asked were: How would you rate your emotional or mental health? How would you rate your self-esteem? In the last 7-days how often have you felt depressed? A series of psychological distress questions. Self-Rated Emotional or Mental Health Response options for this question included: excellent, very good, good, fair, and poor. We combined options fair and poor to indicate potential poor self-rated mental health. Overall, 16.6% (95% C.I.: 13.2, 20.8) of LGL students reported poor self-rated mental health. This rate was statistically significantly higher than Ontario overall at 11.7% (95% C.I.: 10.3, 13.1). Rates for females were higher than males but not significantly so. Rates for secondary school students in LGL were significantly higher at 19.7% ( ) than those in primary school (Figure 19). A definite upwards trend associated with student grade level can be seen with the lowest rates reporting from grade 8 students at 8.1% (95% C.I: 3.5, 17.5) and the highest from grade 12 students at 23.3% (95% C.I.: 13.4, 37.4) (Figure 19). Figure 19: Percentage reporting fair to poor mental or emotional health by demographic. Page 13

14 Mental & Emotional Health (cont.) Self-Rated Self-Esteem and Depression The OSDUHS used an adapted six-item tool to determine measures of student self-esteem. 8.7% (95% C.I.: 6.4, 11.9) of students responded that their self-esteem was low. This is identical to Ontario overall. Females responded more often than males that their self-esteem was low 11.2% (95% C.I.: 7.4, 16.6) versus 6.2% (95% C.I.: 3.0, 12.2). However, these differences were not statistically significant. Low levels of self-esteem were also associated with being in secondary school with students reporting low self esteem 10.0% of the time versus 5.8% with primary school students (Figure 20). In reporting frequency of depression we combined the response categories of often and always together to indicate if a student was feeling depressed during the 7-days prior to the survey. Similar rates were reported between LGL and Ontario overall as well as between males and females. There were no statistically significant differences among school types or grades (figure 21). The rates for grades 11 and 12 were not reportable. Figure 20: Percentage reporting low rates of self-esteem by demographic. Figure 21: Percentage reporting frequency of being often or always depressed by demographic. Page 14

15 Mental & Emotional Health (cont.) Elevated Psychological Distress The OSDUHS used the General Health Questionnaire to identify symptoms reported by students that are indicators of elevated psychological distress. The three top reported symptoms experienced by LGL students were: feeling constantly stressed, feeling depressed and unhappy and losing sleep over worry. These were also the top reported symptoms by sex, although the order was different with females reporting losing sleep over worry in second place and males reporting it in third (Figure 22). A total of 33.0% (95% C.I.: 26.1, 40.8) of females reported losing sleep over worry. This rate was statistically significantly higher than for males at 17.3% (95% C.I.: 11.5, 25.3). Overall, females scored higher on all symptom categories. However, none of the differences between males and females were statistically significant except for losing sleep over worry. Figure 22: Percentage reporting elevated psychological distress symptoms by sex. Page 15

16 This section examines behaviours that have a negative effect on both individuals and society overall. The delinquent behaviours presented are both for violent and non-violent activities over the 12-months prior to the survey. The questions associated with bullying were related to the way students were bullied at school only since September (start of the school year) of the year the survey was asked. The questions asked were: A series of 13 delinquency questions. Since September, how often were you bullied at school? Since September, in what way were you bullied the most at school? Delinquent Behaviour Mental Health & Wellbeing of Students in Leeds, Grenville & Lanark (2009) Delinquent Behaviour & Bullying This question asked if a student had engaged in any of the 13 delinquent behaviours listed in the survey. The responses were then categorized into an ever/never response rate. Therefore, the rates may be higher in the figure below than those reported in other research as students who committed one delinquent behaviour in the preceding year are counted together with those who committed multiple delinquent events. Similar rates of delinquent behaviour were reported for both LGL and Ontario overall. However, rates for delinquent behaviour were significantly higher for males 51.8% (95% C.I.: 42.3, 61.1) versus females 28.8% (95% C.I.: 22.3, 36.4). The trend for delinquent behaviour in LGL was fairly similar between primary and secondary school respondents and fairly flat in terms of school grade of respondent with an uptick in rates observed for grade 12 students (Figure 23). Figure 23: Percentage reporting delinquent behaviour by demographic. Page 16

17 Delinquent Behaviour & Bullying (cont.) Delinquent Behaviour (cont.) Of those who reported delinquent behaviour in the year preceding the survey, vandalism is the most often reported type of delinquency at 15.9% (95% C.I.: 12.1, 20.6). Fighting at school and petty theft are the two next highest rates of delinquency reported (Figure 24). Figure 24: Percentage reporting delinquent behaviour by type of delinquency. Bullying The OSDUHS survey defines bullying as...when one or more people tease, hurt or upset a weaker person on purpose, again and again. It is also bullying when someone is left out of things on purpose. The rates of reported bullying in LGL were statistically significantly higher than Ontario overall at 35.3% (95% C.I.: 30.2, 40.7). Similar rates were reported between males and females and between primary and secondary schools. There was no definite trend associated with grade level of the respondents with the highest rate being reported by grade 9 students (Figure 25). Figure 25: Percentage reporting being bullied at school by demographic. Page 17

18 Delinquent Behaviour & Bullying (cont.) Bullying (cont.) Mental Health & Wellbeing of Students in Leeds, Grenville & Lanark (2009) Of the 35.3% of students who reported being bullied, 71.0% (95% C.I.: 62.9, 77.9) reported the frequency of their bullying at about once a month or less. A further 29% reported being bullied about once a week or more with almost 10% reporting being bullied on a daily basis (Figure 26). Of those bullied, 82.8% (95% C.I.: 74.8, 88.7) reported the most common way they were bullied was by verbal attacks, followed by 14.1% (95% C.I.: 8.4, 22.9) who reported physical attacks and 3.0% (95% C.I.: 1.4, 6.6) reporting having their personal property damaged or stolen (Figure 27). Figure 26: Percentage reporting frequency of bullying they were subjected to at school. Figure 27: Percentage reporting type of bullying they were subjected to at school. Page 18

19 Gambling Activity This section examines gambling behaviours of students during the 12-months prior to the survey. The questions asked were: In the past 12-months have you gambled? How often, in the past 12-months have you done each of the following (list of gambling activities)? What is the largest amount you have gambled at one time in the past 12-months? Gambling in Past 12-Months This question asked if a student had engaged in any of the 10 gambling activities listed in the survey. The responses were then categorized as an ever/never response rate. Therefore, the rates may be higher in the figure below than those reported in other research as students who participated in one gambling activity during the preceding year are counted together with those who may have gambled on many occasions. Similar rates of gambling activity were reported for both LGL and Ontario overall. However, gambling rates were significantly higher for males 55.5% (95% C.I.: 46.9, 63.9) versus females 37.1% (95% C.I.: 30.2, 44.6) in LGL. The gambling rate in LGL was higher for secondary school students compared to primary school students but the difference was not statistically significant. The trend for gambling activities associated with school grade was upwards overall with the lowest rates reported by grade 7 students and the highest by grade 11 students (Figure 28). Figure 28: Percentage reporting any gambling activity by demographic. Page 19

20 Gambling Activity (cont.) Type of Gambling & Amount Bet Students who reported any gambling activity in the 12-months prior to the survey were then asked what type of gambling activity they participated in. Playing cards, betting money in ways not listed and sports pools were the top three activities reported (Figure 29). When asked what was the largest bet made at any one time in the past 12-months, 61.3% reported betting less than $10 at any one occasion. However, 29.8% (95% C.I.: 19.7, 42.5) reported betting up to $50 and a further 8.9% (95% C.I.: 4.7, 16.4) reported betting $50 or more (Figure 30). Figure 29: Percentage reporting type of gambling activity. Figure 30: Percentage reporting size of gambling bets made. Page 20

21 About the Data The OSDUHS survey is an ongoing cross-sectional epidemiological study of Ontario students that has been conducted bi-annually by the Centre for Addiction and Mental Health (CAMH) for over 30 years. The aim of the survey is to describe the prevalence, incidence and trends for various mental and physical health and risk behaviours of Ontario students in grades 7 through 12 enrolled in both the public and Catholic school systems. In 2009, LGLDHU and several other health units participated in an oversampling of schools in our various jurisdictions. Some of the results related to mental health and wellbeing are presented in this document. LGLDHU oversampled 8 elementary and 8 secondary schools to obtain a sample of 872 students. The OSDUHS data is robust in that it represents a weighted sample of almost 1-million Ontario students. The OSDUHS survey employs a weighted complex probability stratified cluster design that accounts for populations that are unequally represented (e.g. older teen-age males tend to be under-represented). This allows for the sample obtained to properly represent the entire Ontario student population. The analysis presented in this report is relevant to public health and education in general as it can be used to inform and guide health curricula that is more specific to LGL than the traditional regional OSDUHS reports generated by CAMH. As this is the first time LGLDHU has participated in the oversampling of the OSDUHS there is no way to present data trends over time. Continued participation in the oversampling project will allow for trend analysis in the future. LGLDHU will be participating in the next OSDUHS round in References: 1. Centre for Addiction and Mental Health Canadian Community Health Survey Questionnaire and Reporting Guide. Statistics Canada Cole, T.J., Freeman, J.V. and M.A. Preece. Body mass index curves for the UK, Archives of Disease in Childhood, no 73 Primary Business Address 458 Laurier Blvd Brockville, ON K6V 7A3 Phone: Fax: epi@healthunit.org The Leeds, Grenville & Lanark District Health Unit offers a wide range of services to promote healthy living, healthy growth and development, prevent illness and injury and control communicable diseases in the community. Services are available to individuals and groups of all ages in a variety of places. A referral is not needed for any service. We publish and update health-related information on our website on a continual basis. Visit us online at: For more information about this report please contact the Epidemiologist at The Leeds, Grenville and Lanark District Health Unit, at or Page 21