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The
Health of Children and Young People
 7 Health status
Melanie Doyle
7.1 Introduction 7.1.1 Introduction This chapter covers self-reported longstanding illness and acute sickness, general health, psychosocial health, use of dental services and prescribed medicines. Questions about health status and the use of dental services were asked in the interview while questions about the use of prescribed medicines were asked during the nurse visit. Questions relating to psychosocial health (the 12-item General Health Questionnaire (GHQ12)), social support and behavioural problems (the Strengths and Difficulties Questionnaire (SDQ)) were in self-completion format. A parent or guardian answered on behalf of children aged 0-12 (with the child present). Informants aged 13 and over answered questions directly, with the exception of the SDQ, which was asked of parents of those aged 4-15. A number of issues should be taken into account when considering the results presented in this chapter. Firstly, the findings are based on informants' subjective views and such self-reported illness may not correspond with medical diagnoses.1 Secondly, there is evidence that informants may under-report some conditions, such as mental illness, in health surveys.2 Finally, only people living in private households were included in the survey (institutions were not surveyed), and those who were too ill to be interviewed were excluded. Descriptive statistics are shown for the main variables analysed by age, sex, socio-economic status (NS-SEC) of household reference person (HRP), Index of Multiple Deprivation (IMD), equivalised household income and Government Office Region (GOR). Comparisons with data from the 1997 report3 are presented and logistic regression is used to examine key health status variables, namely longstanding and limiting longstanding illness and general health. 7.1.2 Standard break variables NS-SEC is a social classification system that attempts to classify groups on the basis of employment relations, based on characteristics such as career prospects, autonomy, mode of payment and period of notice. The five categories used are managerial and professional, intermediate, small employers and own account workers, lower supervisory and technical, and semi-routine and routine occupations. Equivalised household income is a measure that takes into account the number of persons in the household. The exact thresholds of the quintiles vary from year to year. The Index of Multiple Deprivation (IMD) is based on area deprivation in six domains, namely income; employment; health deprivation and disability; education, skills and training; housing; and access to services. In the Health Survey, deprivation quintiles are used to reflect broad categories of deprivation. Government Office Region (GOR) is the key geographical variable used. The nine regions are North East, North West, Yorkshire and the Humber, East Midlands, West Midlands, East England, London, South East and South West. 7.2 Self-reported longstanding illness 7.2.1 Introduction Informants were asked whether they had any longstanding illness, disability or infirmity that had troubled them over a period of time or was likely to affect them over a period of time. Informants who reported such an illness were asked about the nature of their condition (details of up to six longstanding illnesses could be recorded) and whether it limited their activity in any way. Longstanding illnesses were coded into categories defined in the International Classification of Diseases (ICD),4 but it should be noted that the ICD is used mostly to classify conditions according to the cause, whereas the Health Survey for England (HSE) classifies according to the reported symptoms. 7.2.2 Prevalence of longstanding illness Among those aged 0-15, the prevalence of longstanding illness was significantly higher for boys (24%) than girls (20%). There was no clear association with age. A small proportion (5% of boys and 4% of girls) reported having two or more conditions. The prevalence of longstanding illness among young adults aged 16-24 did not differ significantly by sex (young men 25% and young women 26%). As with the younger group, there was no clear pattern of association with age and, again, the proportion with more than one condition was small (5% of young men and 6% of young women). Table 7.1 The question on longstanding illness in the General Household Survey (GHS) is identical to that used in HSE. The table below shows the prevalence of longstanding illness in HSE and GHS.5 While the reported prevalence of longstanding illness is higher in HSE than in GHS, the pattern of prevalence across age and sex is similar in both surveys. The difference in prevalence may be due to the different context provided by the two surveys: GHS is a general survey, while HSE focuses exclusively on health and health related behaviours. Among males in HSE, prevalence of longstanding illness
was higher among those aged 5-15 (27%) and 16-24 (25%) than those aged
0-4 (17%). Among females, prevalence of longstanding illness increased
across age bands from 0-4 (14%) to 5-15 (22%) and 16-24 (26%).
7.2.3 Types of longstanding illness As previously stated, longstanding illnesses were classified using the ICD10.4 Tables 7.2 and 7.3 show the rates per 1000 people reporting a longstanding illness in each of the major ICD groups. Figure 7A shows prevalence (per thousand) for the most commonly reported longstanding illnesses illnesses with prevalence higher than 10 per 1000 are shown. The most commonly reported conditions were classified under the ICD group relating to the respiratory system (rate per thousand 123 for boys and 99 for girls), followed by skin complaints (45 per thousand boys and 43 per thousand girls). Ear complaints and disorders of the digestive system were each reported by 18 per thousand boys and 14 per thousand girls. Mental disorders were more common among boys (27 per thousand) than girls (10 per thousand). As with children, the most commonly reported illnesses among young adults were those classified as respiratory disorders (rate per thousand 115 young men and 108 young women). However, young adults reported a higher prevalence of musculoskeletal disorders than children (rate per thousand 56 for young men, 54 for young women). Other commonly reported illnesses were nervous system conditions, skin complaints and mental disorders which were reported by at least 21 per thousand young men and 25 per thousand young women. Tables 7.2, 7.3, Figure 7A
7.2.4 Longstanding illness by NS-SEC, equivalised household income, Index of Multiple Deprivation and Government Office Region Tables 7.4 to 7.11 show the prevalence of longstanding illness by NS-SEC of household reference person, equivalised household income, Index of Multiple Deprivation (IMD) and Government Office Region (GOR). There was some association with socioeconomic factors, namely equivalised household income and NS-SEC of household reference person. There was some regional variation, but no association with area deprivation (IMD). There was no marked pattern across NS-SEC category, however prevalence of longstanding illness was highest among boys and girls in semi-routine and routine households (26% for boys and 22% for girls). The prevalence of longstanding illness for young men was lowest in the small employers and own account workers group (19% compared with an average of 25%). There was very little difference between the groups for young women. Tables 7.4, 7.5 Tables 7.6 and 7.7 and Figure 7B show the prevalence of longstanding illness by equivalised household income. Among children (aged 0-15), the prevalence of longstanding illness was highest in the lower income quintiles (27% for boys in the lowest and 28% in the second lowest quintile, 23% for girls in the lowest quintile) and lowest in the highest income quintile (19% for boys and 16% for girls). A similar pattern of association with equivalised household income was found for those aged 16-24. The prevalence of longstanding illness was highest among those in the lowest income quintile (31% for men and 30% for women). Among young men, it was lowest for those in the highest income quintile (22%). Tables 7.6, 7.7, Figure 7B
There
was no clear pattern of longstanding illness when analysed by area deprivation
(IMD). Tables 7.8, 7.9 The prevalence of longstanding illness was lowest in the London region for boys (19%) and girls (15%). This compared with prevalence in other regions between 23% and 28% for boys and between 19% and 22% for girls. There was no consistent pattern among young adults aged 16-24. Tables 7.10, 7.11
7.2.5 Logistic regression of factors associated with longstanding illness Multivariate logistic regression was used to determine the independent factors associated with having longstanding illness. Unlike simple standardisation, which only adjusts for one variable (such as age) this regression technique adjusts for several explanatory variables simultaneously. The binary dependent variable was longstanding illness. The following variables were included as potential explanatory factors: age, self-assessed general health, equivalised household income, NS-SEC of household reference person, area deprivation (IMD) and Government Office Region. Separate models were run for males and females and each model included informants aged 0-24. Table 7.12 shows the adjusted odds ratios (OR) for factors included in the model. All odds ratios are compared with a reference category (OR=1). An odds ratio greater than 1 indicates that the odds of having longstanding illness are greater in that category than for the reference category by the number of times indicated by the odds ratio - it has a multiplicative effect. Conversely, a ratio of less than 1 indicates that the odds of having longstanding illness are lower than those for the reference category. The 95% confidence intervals may be used to determine the significance of differences between categories. If the interval does not include one, it is significant. For example, an interval of 1.46-1.95 is significantly different from the reference category, whilst an interval of 0.67-1.21 is not. The outcomes of the regression models are discussed below. Age and self-assessed general health were significantly associated with longstanding illness for males and females. The odds of reporting longstanding illness increased significantly with age for both males and females. With each year of age the odds of reporting longstanding illness were 1.02 times higher among males and 1.03 times higher among females. Relative to those with very good/good health, males and females with fair health were around 6 times more likely (5.58 for males and 6.28 for females) to report longstanding illness. Those who reported having bad/very bad health were 10.27 (males) and 23.34 (females) times more likely to have a longstanding illness. Among males, equivalised household income was also significant, with the probability of reporting a longstanding illness increasing with decreasing income. Males in the lowest and second lowest income quintiles were more likely (1.35 and 1.36 times respectively) to have a longstanding illness than those in the highest income quintile. Government Office Region was also associated with longstanding illness among males. Relative to those in London, males in the South East, South West, North East, North West and East Midlands were more likely (at least 1.26 times) to report a longstanding illness. NS-SEC of the household reference person and area deprivation (IMD) were not significantly associated with having longstanding illness and hence removed from the models. Table 7.12 7.3 Limiting longstanding illness 7.3.1 Introduction Informants who reported a longstanding illness were asked whether the illness limited their activities in any way. 7.3.2 Prevalence of limiting longstanding illness The prevalence of reported limiting longstanding illness among informants aged 0-15 was 8% for boys and 7% for girls. Among informants aged 16-24, the prevalence was 10% for young men and 12% for young women. Overall, approximately a third of longstanding illnesses were perceived to be limiting. Table 7.1 The table below shows the prevalence of limiting longstanding illness in HSE and GHS, by age group and sex.5 Among those aged 0-4 and those aged 5-15 the prevalence of longstanding illness was similar in HSE and GHS. However, reported prevalence for young adults, aged 16-24, was higher in HSE than in GHS.
7.3.3 Limiting longstanding illness by NS-SEC, equivalised household income, Index of Multiple Deprivation and Government Office Region Tables 7.4 to 7.11 show limiting longstanding illness by NS-SEC, equivalised household income, Index of Multiple Deprivation and Government Office Region. The pattern of limiting longstanding illness was similar to that of longstanding illness, described above. Among children, the pattern of association with NS-SEC of the household reference person echoed that found for longstanding illness, with the highest prevalence (11% for boys and 10% for girls) found in semi-routine and routine households. The prevalence of limiting longstanding illness was also highest for semi-routine and routine households among informants aged 16-24: 12% of males (compared with 10% overall) and 14% of females (compared with 12% overall). Tables 7.4, 7.5 Among boys, the prevalence of limiting longstanding illness
increased as income decreased, from 5% of those in the highest income
quintile to 12% of those in the lowest quintile. The pattern was less
marked among girls, though the prevalence in the lowest income quintile
(9%) was significantly higher than in the highest income quintile (5%).
Similar results were found for informants aged 16-24.
Among young men, 8% of those in the highest income quintile reported a
limiting longstanding illness, compared with 15% in the lowest income
quintile. Among young women, the corresponding figures were 11% (highest
income quintile) and 17% (lowest). Tables 7.6, 7.7 No strongly marked association emerged between the prevalence of limiting longstanding illness and area deprivation (IMD), though the prevalence was higher in the most deprived quintile among informants aged 0-15 for boys (10%) and girls (8%) than in the least deprived quintile (7% of boys and 6% of girls). The same was true for young adults aged 16-24, 13% of males and 15% of females in the most deprived IMD quintile reported a limiting longstanding illness compared with 8% of males and 10% of females in the least deprived IMD quintile. Tables 7.8, 7.9 Among boys aged 0-15, the prevalence of limiting longstanding illness was lowest in the West Midlands (7%) andhighest in the North East (12%). Among girls of this age, prevalence was lowest in London and the South East (both 6%) and highest in Yorkshire and the Humber (10%). The prevalence of limiting longstanding illness among young men aged 16-24 was lowest in the East and West Midlands (both 7%) and highest in East England (12%). Among young women, the lowest prevalence was in the North West (10%) and the highest was also in East England (15%). Tables 7.10, 7.11 7.4 Self-reported acute sickness 7.4.1 Introduction Informants were asked whether they had experienced any illness or injury over the past two weeks that caused a decline in their usual activities. In this chapter, illness or injury experienced within the past two weeks is referred to as 'acute sickness'. To assess its severity, those who reported acute sickness were asked on how many days over the last two weeks they had been affected. 7.4.2 Prevalence of self-reported acute sickness Overall, 13% of boys and girls aged 0-15 reported having had an acute sickness in the past two weeks. Within this age group, 7% of boys and 8% of girls reported that their activity had been limited on one to three days. Among those with acute sickness, both girls and boys reported an average of 4.3 days sickness in the past two weeks. The prevalence of acute sickness among young adults was 11% for men and 14% for women. The average number of days on which sickness affected usual activities was 5.7 days for both men and women. The prevalence of acute sickness among young women was generally higher among those in their twenties (at least 18% for those aged 23 and 24) than those in their late teens (between 10% and 13% for those aged 16-19). No such difference was found for young men. Table 7.13 7.4.3 Acute sickness by NS-SEC, equivalised household income, Index of Multiple Deprivation and Government Office Region Tables 7.14 to 7.21 show acute sickness by NS-SEC of household reference person, equivalised household income, area deprivation (IMD) and Government Office Region. There was some association with NS-SEC for young men and women and some regional variation, but no association with equivalised household income or Index of Multiple Deprivation. No marked patterns were seen for boys or girls in the prevalence of acute sickness by NS-SEC of household reference person, but some differences were found in the 16-24 age group. Among males aged 16-24, the prevalence of acute sickness was significantly higher for those in semi-routine and routine households (13%) than those in the small employer and own account worker group (8%). In contrast, among young women, prevalence of acute sickness was lower in semi-routine and routine households (11%) than in any other category (at least 15%). Tables 7.14, 7.15 There was no clear pattern of acute sickness when analysed by equivalised household income or area deprivation (IMD). Tables 7.16, 7.17, 7.18, 7.19 The prevalence of self-reported acute sickness across Government Office Region is shown in the table below. Among males and females of all ages, the prevalence of acute sickness was lower in London than in most other regions. Among boys aged 0-15, the prevalence was significantly lower for informants in London (10%) than for those in the North East, North West and Yorkshire (all 15%). Among girls aged 0-15, prevalence was also significantly lower in London (9%) than in most other regions. For young men aged 16-24, the prevalence of acute sickness was lower in London (9%) and the East Midlands (8%) than East England (15%). Among women, prevalence ranged from 10% in London to 15% in East England and 17% in both Yorkshire and the East Midlands. Tables 7.20, 7.21
7.5 Self-assessed general health 7.5.1 Introduction Informants were asked to rate their general level of health on a five-point scale that ranged from 'very good' to 'very bad'. For children aged under 13 the rating was made by their parent or guardian whilst those aged 13 and over rated their own health. 7.5.2 Self-assessed general health The majority (93% of boys and girls) reported their health as either very good or good, with more than half reporting their health as very good (57% of boys and girls). Only 1% of boys and girls reported their health as bad or very bad. Among young adults (16-24) the majority of men and women rated their health as very good or good, though men were significantly more likely than women to report very good or good health (87% of men and 84% of women). Only 1% of men and 3% of women rated their health as bad or very bad. When viewed across the entire 0-24 age range, the prevalence of very good and good general health appears to be high (at least 90%) up to age 18 for males and age 16 for females, after which it decreases (to a maximum of 88%). Table 7.22 The table below shows the prevalence of very good or good general health based on data from the Health Survey and from the General Household Survey. Note that GHS used only three response categories (good, fair and bad) whereas HSE had five (very good, good, fair, bad and very bad). The prevalence of very good/good health reported in HSE is higher than the prevalence of good health reported in the GHS for all groups. This may be due to the different contexts provided by the two surveys and the different scales used.
7.5.3 Self-assessed general health by NS-SEC, equivalised household income, Index of Multiple Deprivation and Government Office Region Tables 7.23 to 7.30 show self-assessed general health by NS-SEC, equivalised household income, area deprivation (IMD) and Government Office Region. The pattern of general health was significantly associated with NS-SEC of household reference person, equivalised household income and area deprivation (IMD). There were also differences by Government Office Region. Among boys, informants in semi-routine and routine households were less likely to report very good or good health (89%) than informants in all other groups (at least 94%). Among girls, the proportion reporting very good or good health in semi-routine and routine households (91%) was significantly lower than that for managerial and professional (95%) and intermediate households (94%). Among young men and women, the prevalence of reported very good or good health was also lower in the semi-routine and routine group (85% of males and 82% of females) than in the managerial and professional category (89% of men and 87% of women). Tables 7.23, 7.24 Tables 7.25 and 7.26 and Figure 7C show self-assessed general health by equivalised household income quintile. Among boys and girls, there was significant variation in self-reported health across household income quintiles, with the proportion reporting very good or good health being significantly higher in the top three quintiles (between 94% and 97%) than in the bottom two (between 89% and 91%). For young men, there was little variation in general health across income quintiles. Among young women there was a difference in the prevalence of reported good and very good health between the lowest and second lowest income quintiles (76% and 82% respectively) and the top three quintiles (at least 87%). Tables 7.25, 7.26, Figure 7C In terms of area deprivation (IMD), boys in the most deprived quintile reported lower levels of very good and good health (90%) than those in all other quintiles (between 92% and 96%). Among girls, the percentage of informants in very good and good health was also lower among the most deprived (91%) than among the three least deprived quintiles (93% and above). There
was no significant variation in the proportion of very good and good health
across the IMD quintiles for young men (aged 16-24). Among young women
the proportion reporting very good or good health was significantly lower
in the most deprived quintile (82%) than in the least deprived quintile
(88%). Tables 7.27, 7.28 Among children, there was little variation by region, though a significantly lower percentage of boys in the North East reported very good or good health (90%) than those in London, the South East, the South West, East England and the West Midlands (at least 93%). Among young men, the proportions reporting very good or good health were highest among those in London, the South West, the North East and North West (at least 88%) and lowest in the South East (82%). Among women the proportions with very good or good health were highest in the North West and West Midlands (both 87%) and lowest in East England (82%) Tables 7.29, 7.30 7.5.4 Logistic regression of factors associated with very good self-assessed general health Multivariate logistic regression was used to determine the independent factors associated with having very good self-assessed general health. The dependent variable was a binary variable indicating whether the person reported very good health. The following variables were chosen as potential explanatory factors: age, longstanding illness, acute sickness, equivalised household income, NS-SEC of household reference person, area deprivation (IMD) and Government Office Region. The models were run separately for males and females aged 0 to 24 years. The table shows the adjusted odds ratios for factors included in the model. The odds ratio indicates the likelihood of very good general health, relative to the reference category and an associated p-value of less than 0.05 indicates a significant effect of the variable on the probability of the outcome variable, which is having very good health. Similarly a 95% confidence interval that does not include one is significantly different from the reference category. The outcome of the regression is discussed below. All the explanatory variables were significantly associated with having very good health for both males and females. Please note that the descriptive statistics presented earlier were based on the proportions of those with good and very good health, whereas the regression is based only on those reporting very good health. Very good health was selected as the variable for regression as the prevalence of very good and good health combined was at ceiling. Among those aged 0-24, the odds of reporting very good health decreased with increasing age (by 0.96 per year of age for males and 0.94 for females). The prevalence of very good general health was significantly associated with other health indicators. Those with no longstanding illness were more likely than those with a longstanding illness to report having very good health (3.41 times for males and 4.65 times for females). Males and females with no acute sickness were, respectively, 1.69 and 1.65 times more likely to report very good health than those with acute sickness. Odds of reporting very good health were also significantly associated with socio-economic variables. Relative to those in the semi-routine and routine category, males in the managerial and professional category were 1.35 times more likely to report very good health. Among females, NS-SEC of household reference person was significantly associated with very good general health, but there were no significant differences between those in the semi-routine and routine reference category and the other categories. The odds of having very good health increased with increasing income. Relative to those in the lowest income quintile, males and females in all other quintiles were more likely to report very good general health (at least 1.36 times for males and 1.19 times for females). The pattern of very good health across area deprivation (IMD) quintile mirrored that for income. Relative to those in the most deprived quintile, males and females in the two least deprived quintiles were significantly more likely to report very good general health (at least 1.28 times for males and 1.21 times for females). Government Office Region was also significantly associated with general health. Relative to those in London, males in all other regions were more likely (at least 1.33 times) to report very good general health. Among women, all regions (except East England and the East Midlands) were more likely than those in London (at least 1.25 times) to report very good general health. Table 7.31 7.6 Health status in 1997 and 2002 7.6.1 Prevalence of longstanding illness and limiting longstanding illness in 1997 and 2002 The following comparisons examine the prevalence of longstanding illness and type of longstanding illness in 1997 and 2002. Data from 1995-1997 and from 2001-2002 are used in this comparison (referred to below as 1997 and 2002 respectively). This analysis excludes children aged 0-1 as they were not included in the Health Survey until 2001. Large sample sizes mean that relatively small changes in the prevalence of longstanding and limiting longstanding illness are significant. In both children and young adults there was a decrease of one or two percentage points between 1997 and 2002 in the prevalence of longstanding illness and limiting longstanding illness. The only exception was among young men (aged 16-24) where the prevalence of longstanding illness increased from 23% to 25%. The mean number of longstanding illnesses among those who reported a longstanding illness was similar in 1997 and 2002. Overall, children and young adults with a longstanding illness had a mean of 1.2-1.3 longstanding illnesses in both survey years.
There was some variation with age. Between 1997 and 2002, there was a marked reduction in prevalence of longstanding illness among young children (3-4 years) by over 6% in boys and by 2-4% among girls of this age. Figure 7D shows the prevalence of longstanding illness in 1997 and 2002 by age and sex. Table 7.32, Figure 7D Prevalence
(rate per thousand) for the most common types of longstanding illness
is shown in the table below. The overall pattern of illnesses is similar
for 1997 and 2002, but for some illnesses prevalence has changed over
time. Since 1997, the prevalence of respiratory disorders among children has decreased by 22 per thousand for boys and 13 per thousand for girls. However, the prevalence of mental disorders among boys has increased over this period, from 14 per thousand boys in 1997 to 30 per thousand in 2002. Among young adults, prevalence of respiratory disorders for young women decreased from 128 per thousand in 1997 to 108 per thousand in 2002. In contrast, the prevalence of mental disorders among young men and women has increased since 1997, from 12 to 21 per thousand men and from 11 to 25 per thousand women.
Table 7.33 shows the prevalence of longstanding illness by Social Class in 1997 and 2002. Social Class is used to allow comparison between the two years.7 Within the individual social class categories the only significant change in the prevalence of longstanding illness between 1997 and 2002 was a 6% increase in longstanding illness among young men in Social Class IIINM. Table 7.33 7.6.2 Self-assessed general health in 1997 and 2002 There were small changes in the overall prevalence of good and very good self-assessed general health between 1997 and 2002. Although relatively small, a number of changes were statistically significant because of the large sample sizes. Table 7.34 shows the prevalence of good and very good self-assessed general health, by age and sex, among those aged 2-24, in 1997 and 2002. The overall prevalence of very good and good health is shown in the following table. Among children, there was a significant increase in the prevalence of very good and good general health between 1997 and 2002 (from 91% to 93%). However, the proportion of young adults reporting very good or good health did not change between 1997 and 2002 (87% of men and 84% of women in both years). Table 7.34
Between 1997 and 2002, there was a significant increase in the prevalence of very good and good general health among boys in Social Class IIIM and among boys and girls in Social Classes IV and V combined. As a result, the gradient of very good and good health across social class was less marked in 2002 than in 1997. This data is summarised in the table below. In 1997, the proportion of children reporting very good and good general health increased across social class from 87% of boys and 88% of girls in Social Classes IV and V (combined) to 94% of boys and girls in Social Classes I and II (combined). In 2002, a similar pattern was observed but the gradient was less steep: 90% of boys and 91% of girls in Social Classes IV and V reported very good and good health compared with 95% of girls and boys in Social Classes I and II. Table 7.35
7.7 Self-reported psychological well-being 7.7.1 Introduction Mental health is one of several key areas for which the government have set specific targets for health improvement.8 This area of health improvement covers a range of illnesses, such as schizophrenia, depression and dementia and related symptoms. Increasing awareness of psychological well-being and mental health problems, combined with the increased prevalence of mental health problems highlights the importance of this component of health improvement, particularly among children and young adults.9 There is a great deal of evidence supporting links between psychological and physical health. Mental health has been shown to be related to certain diseases, including cardiovascular disease, and to the impact of illness on functional health status.10,11 Psychological factors also play a part in unhealthy behavioural patterns and may influence whether or not people follow treatment regimes.12,13 Psychological health was assessed in those aged 13 and over using the GHQ12 questionnaire, presented in self-completion format. This questionnaire consists of 12 questions that concern general level of happiness, depression, anxiety and sleep disturbance over the past few weeks.14 As in previous Health Surveys a score of 4 or more was used as the threshold to identify informants with possible psychiatric disorder, and was referred to as a 'high GHQ score'.15 This section focuses on the prevalence of a high GHQ score. The psychological well-being of children aged 4-15 was assessed using the Strengths and Difficulties Questionnaire (see section 7.9 for details), a self-completion questionnaire filled in by their parents. 7.7.2 Prevalence of high GHQ by age and sex Among those aged 13-15, 7% of boys and 13% of girls had a high GHQ score. There were no clear differences by age, but the proportion of girls with a high GHQ score was larger than that of boys at each age. The prevalence of a high GHQ score was similar to that reported in 1997 at most ages (6% of boys and 14% of girls). There was also a clear sex difference among informants aged 16-24, with women more likely than men, to have a high GHQ score. In 2002, 12% of young men and 20% of young women had a high GHQ score. Among young men and women, there was no significant difference in the prevalence of a high GHQ score between 1997 and 2002. Table 7.36
7.7.3 GHQ score by NS-SEC, equivalised household income, Index of Multiple Deprivation and Government Office Region Tables 7.37 to 7.40 show GHQ score by NS-SEC of household reference person, equivalised household income, area deprivation (IMD) and Government Office Region. In contrast to measures of physical health reported above, there were very few associations between these variables and psychological well-being. Among females, prevalence of a high GHQ score was lower in lower supervisory and technical households (13%) than semi-routine and routine, managerial and professional and intermediate households (at least 19%). There were no significant variations across NS-SEC for males. Table 7.37 There was no clear pattern of high GHQ score across income quintiles or across area deprivation (IMD) quintiles. Tables 7.38, 7.39 Among males, the lowest prevalence of high GHQ scores was found in the East and West Midlands (8%) and the highest in the South East (13%). There was no significant variation by Government Office Region for females. Table 7.40 7.7.4 Prevalence of GP consultation about mental, nervous or emotional problems, by age and sex Informants aged 16 and over were asked whether, in the last twelve months, they had contacted their GP or family doctor on their own behalf, either in person or by telephone, about being anxious or depressed, or about a mental, nervous or emotional problem. Informants aged under 16 were asked whether they, or any other member of the household, had talked to a doctor on their behalf about such a problem. Results are shown for those aged 13-24. Results should be interpreted with caution as consultations concerning mental health are likely to be subject to under-reporting. It should also be noted that the question about GP consultations was asked during the interview itself rather than in self-completion format. Overall, 6% of males and 13% of females had consulted a GP about a mental, nervous or emotional problem in the last twelve months. Among males aged 13-24, between 3% and 13% reported visiting their GP about a mental, nervous or emotional problem. The proportion reporting a GP consultation increased from around one in twenty of those aged 16-20 to around one in ten of those aged 22 and over. The proportion of females reporting a GP consultation for a mental, nervous or emotional problem also increased with increasing age, from 7% to 8% of those aged 13-16, to at least 15% of those aged 19 and over. Table 7.41 Table 7.42 and the inset table below show the prevalence of such GP consultations in the last year by GHQ score for those aged 13-24. Those with a high GHQ score were more likely to consult their GP about a mental, nervous or emotional problem than those with a low GHQ score. Of those with a high GHQ score, 18% of males and 28% of females had consulted their GP about such problems within the last year. Table 7.42
7.8 Perceived social support 7.8.1 Introduction A number of studies have found that high levels of social support are associated with mental health and well-being.16 Questions on perceived social support were asked of those aged 16 and over in self-completion format. The perceived social support scale was originally used in the Health and Lifestyle survey.17 Informants were asked about the amount of support and encouragement they received from family and friends. The scale was based on seven questions concerning physical and emotional aspects of social support. From these, a single scale was derived by assigning a score from 1 (lack of support) to 3 (no lack of support) for each of the seven questions. Informants with the maximum score of 21 were classified as having 'no lack of social support', those with a score of 18-20 were classified as having 'some lack of social support' and those with a score less than 18 as having 'a severe lack of social support'. 7.8.2 Social support by age and sex Young men were more likely than young women to report some or a severe lack of social support. Among young men aged 16-24, 54% reported no lack of social support, 30% reported some lack of social support and 16% were classified as having a severe lack of social support. Among young women, 64% reported no lack of support, 25% reported some lack of support and 11% reported a severe lack of support. Questions on social support were first included in the Health Survey in 1998. The table below shows social support scores by sex among those aged 16-24, in 1998 and 2002 (there were no significant differences). Table 7.43
7.8.3 Social support by NS-SEC, equivalised household income, Index of Multiple Deprivation and Government Office Region Tables 7.44 to 7.47 show perceived social support among young adults by NS-SEC of household reference person, equivalised household income, area deprivation (IMD) and Government Office Region. There was a significant association between social support and NS-SEC, equivalised household income, Index of Multiple Deprivation and Government Office Region. The analysis focuses on those reporting a severe lack of social support. The highest prevalence of severe lack of social support was found among those in semi-routine and routine households. 21% of men and 15% of women in semi-routine and routine households reported a severe lack of social support, compared with 12% of men and 6% of women in managerial and professional households. Table 7.44 Table 7.45 and Figure 7E show the prevalence of severe lack of social support, by equivalised household income. The prevalence of severe lack of social support decreased as income increased, from 24% of young men and 18% of young women in the lowest income quintile to 10% of young men and 5% of young women in the highest. Table 7.45, Figure 7E Table
7.46 and Figure 7F show the prevalence of severe lack of social support
by area deprivation (IMD). The proportion of young adults reporting a
severe lack of social support increased as the level of area deprivation
increased. In the most IMD deprived quintile, 22% of men and 15% of women
reported a severe lack of social support compared with 12% of men and
6% of women in the least deprived quintile. Table 7.46, Figure 7F There
was some variation by region in the proportion of men and women classified
as having a severe lack of social support. Among men prevalence ranged
from 13% in the North East to 18% in London and the West Midlands; among
women, prevalence varied from 7% in the North West to 16% in London. Table
7.47 7.8.4 Social support by GHQ score The following comparison examines associations between social support and psychological well-being among those aged 16-24. Key results are summarised in the table below. The data show a clear association between GHQ score and social support. The proportion of young men with a high GHQ score was higher among those with a severe lack of social support (22%) than those with no lack of social support (8%). A similar pattern was found for women. The prevalence of a high GHQ score was significantly higher among females with a severe lack of social support (39%), than those with some lack (23%) or no lack (16%) of social support. Table 7.48
7.9 Parental reports of strengths and difficulties of children 7.9.1 Introduction The Strengths and Difficulties Questionnaire (SDQ) is designed to detect behavioural, emotional or relationship difficulties in children aged 4-15. Questions were administered to parents of children aged 4-15 in self-completion format. The questionnaire consisted of 25 questions, with 5 questions in each of the following domains: hyperactivity, emotional symptoms, conduct problems, peer problems and prosocial behaviour. Each question had three possible answers, which were assigned a score of 0 (not true), 1 (somewhat true) or 2 (certainly true). Scores for individual domains, such as hyperactivity, ranged from 0-10 with higher scores indicating a higher level of problems within that domain. For prosocial behaviour, the scale is reversed so lower scores indicate more difficulties. For analysis, scores in each domain were classified as low, medium, or high (see Table 7.49 for details). Scores for the five questions were summed to provide a domain score. Separate scores were calculated for each of the five domains and a Total SDQ Score (or 'Total Deviance Score') calculated by summing four domain scores (excluding prosocial behaviour). Total SDQ scores were split into three categories termed 'low' (0-13), 'medium' (14-16) and 'high' (17-40): high scores indicate greater emotional, behavioural and relational difficulties. The discussion will focus upon Total SDQ score (referred to as SDQ score). 7.9.2 Strengths and difficulties by age and sex Among those aged 4-15, a significantly higher proportion of boys (12%) than girls (8%) had a 'high' SDQ score. The proportion of girls and boys with 'high' domain scores is shown in the following table. Boys were more likely than girls to have problems with conduct, hyperactivity and relationships with peers, whilst girls were more likely than boys to have emotional problems. Among boys, the most commonly reported problems were for hyperactivity (18%), with conduct (15%) and peer problems (14%) being the next most common. Among girls, the most common problems were emotional (12%), conduct (12%) and peer problems (11%). Table 7.49
7.9.3 Strengths and difficulties by NS-SEC, equivalised household income, Index of Multiple Deprivation and Government Office Region Tables 7.50 to 7.54 show the Total SDQ score and scores for the five domains by NS-SEC of household reference person, equivalised household income, area deprivation (IMD) and Government Office Region. NS-SEC, equivalised household income and Index of Multiple Deprivation showed a significant association with the prevalence of high SDQ scores. There was no clear pattern of variation across Government Office Region. Table 7.50 shows SDQ scores by NS-SEC of household reference person. The pattern of high Total SDQ scores is highlighted in the table below. The prevalence of high SDQ scores among boys varied across NS-SEC with the lowest prevalence (7%) in managerial and professional households and the highest in semi-routine and routine (19%) households. Among girls, the prevalence of high SDQ scores was lowest among those in managerial and professional households (4%) and small employers and own account workers (4%) and highest among those in semi-routine/routine (13%) households. Table 7.50
The prevalence of high SDQ scores decreased as household income increased. High SDQ scores were reported for 21% of boys in the lowest income quintile and 3% of those in the highest income quintile. Among girls, a similar, but less marked, pattern was observed: 12% of girls in the lowest income quintile had a high SDQ score, compared with 2% in the highest quintile. Table 7.51 The proportion of boys with a high SDQ score increased from 7% in the least deprived IMD quintile to 15% in the most deprived quintile. Among girls, the prevalence of high SDQ scores increased from 4% in the least deprived quintile to 9% in the most deprived. Table 7.52 The prevalence of high SDQ scores among boys was lowest in London (9%) and highest in the North East (18%). For girls, the corresponding prevalence was lowest in London and East England (both 6%) and highest in the North East (12%). Table 7.53 7.9.4 Use of services for behavioural or developmental problems The Health Survey also asked whether parents had consulted a professional in the past six months about a child's behavioural or developmental problem. A range of professionals were listed, including GP, practice nurse, consultant, school or community nurse, psychologist, social worker and teacher, and the parent was asked to indicate whether or not they had consulted each one. Overall, 40% of boys' parents and 29% of girls' parents had contacted a professional in the past six months about behavioural or developmental problems that their child was experiencing. For boys and girls, the most commonly contacted people were teachers (24% of boys and 16% of girls), general practitioners (18% of boys and 12% of girls) and health visitors (15% of boys and 11% of girls). 10% of boys' parents and 6% of girls' parents reported having talked to a consultant, specialist or other doctor. There was some variation across the age range. Although there was no pattern in the overall prevalence of consultations, there were some differences in the type of professional consulted. Health visitors were the main contact for younger children (at least 27% of boys and 22% of girls aged 4-5 years) and teachers were the most common contact for problems with older children (24% to 30% of boys aged 7 and over, 15% to 19% of girls aged 10 and over). Table 7.54 Among boys, parents had consulted a professional for 82% of those with a high SDQ score, 61% of those with a medium score and 32% of those with a low score. Among girls a similar pattern was observed with professional consultations for 72% of girls with a high SDQ score, 50% of those with a medium score and 23% with a low score. It is interesting to note that, among those with a high SDQ score, parents were significantly more likely to contact a professional for problems with boys (82%) than with girls (72%). This sex difference may reflect the different nature of the behavioural problems displayed by boys and girls (while boys exhibited a higher prevalence of hyperactivity and conduct problems, girls had a higher prevalence of emotional problems).
The choice of professional was similar across SDQ score. Teachers, general practitioners and health visitors were the professionals most likely to be contacted by parents, irrespective of SDQ score. Table 7.55 7.10 Use of dental services 7.10.1 Introduction Questions about use of dental services were asked of those aged 2 and over. Different questions were asked of young adults (aged 16-24) and children (aged 2-15). For those aged 2-12, the parent answered the questions (with the child present); those aged 13 and over answered for themselves. Young adults were asked whether they had experienced any toothache or severe discomfort with their teeth in the last six months. They were also asked about visits to the dentist, specifically whether, in general, they went for a regular check-up, an occasional check-up or only when they were having trouble with their teeth. Children (aged 2-15) were asked whether they had ever been to a dentist and, if so, the reason for their last visit. They were also asked whether they had experienced toothache during the last four weeks. 7.10.2 Use of dental services by age and sex Among those aged 2-15, 87% of boys and 88% of girls had visited a dentist at least once. The proportion who had visited a dentist increased with increasing age from at least 52% of those aged 2, to at least 67% of those aged 3, and at least 91% of those aged 7 and over. Overall, the proportion who reported regular check-ups increased with age from 2-15 and then decreased. The majority of children (79% of boys and 80% of girls) had gone for a regular check-up on their last visit to the dentist. A relatively small proportion had visited because they were having trouble with their teeth (14% of boys and girls). Among young men and women, 49% of men and 55% of women reported that, in general, they visited the dentist for a regular check-up while 30% of men and 25% of women only visited the dentist when having trouble with their teeth. Table 7.56 7.10.3 Use of dental services by NS-SEC, equivalised household income, area deprivation (IMD) and Government Office Region Tables 7.57 to 7.64 show use of dental services by NS-SEC of household reference person, equivalised household income, Index of Multiple Deprivation and Government Office Region. The pattern of service use varied across NS-SEC, equivalised household income and area deprivation quintile. Those in semi-routine and routine households reported lower prevalence of regular dental check-ups. Children in managerial and professional households (83% of boys, 84% of girls) were more likely to have last visited the dentist for a regular check-up than those in semi-routine and routine households (75% of boys, 77% of girls). In general, young men (59%) and women (64%) in managerial and professional households were more likely to visit the dentist on a regular basis than those in semi-routine and routine households (40% of young men, 50% of young women). Tables 7.57, 7.58 Tables 7.59 and 7.60 and Figure 7G show the pattern of dental use by equivalised household income. Although the overall proportion of informants visiting the dentist for regular check-ups varied only slightly across income, the pattern of dental use did vary. As income decreased the proportion of informants who never went to the dentist or visited the dentist only when they had trouble with their teeth increased, while the proportion having a regular check-up decreased. This pattern was more marked among young adults than children. In the lowest income quintile 73% of boys and 75% of girls had last visited the dentist for a regular check up compared with 82% of boys and 84% of girls in the highest income quintile. Among informants aged 16-24, 38% of men and 44% of women in the lowest income quintile generally visited the dentist for a regular check-up compared with 58% of men and 60% of women in the highest income quintile. Tables 7.59, 7.60, Figure 7G The prevalence
of regular check-ups by area deprivation (IMD) is shown in Tables 7.61,
7.62 and Figure 7H. The pattern of dental use by area deprivation (IMD)
was similar to that for income. A larger proportion of children in the
least deprived quintile (83% of boys and 81% of girls) had regular check-ups
than those in the most deprived quintile (75% of boys and 77% of girls).
This pattern was more marked among young men and women: 58% of young men
and 68% of young women in the least deprived quintile had regular check-ups
compared with 38% of young men and 48% of young women in the most deprived
quintile. The opposite pattern was found when considering those who only
visited the dentist when having trouble with their teeth. Tables
7.61, 7.62, Figure 7H Among children and young adults, the highest proportion having regular check-ups was in the South West and the lowest in London (with the exception of boys aged 2-15 where the reported prevalence was lower in the North East than in London). While 83% of boys and girls in the South West last visited the dentist for a regular check-up, 77% of boys and 78% of girls in London did so. Among young adults, those in the South West also reported the highest proportion of regular check-ups (54% of men and 63% of women) while those in London reported the lowest (38% of men and 42% of women). Tables 7.63, 7.64
7.11 Use of prescribed medicines 7.11.1 Introduction Information about the use of prescribed medicines was collected for all informants. Medicines were coded using the British National Formulary.19 It should be noted here that the Health Survey assesses the use of prescribed medicines and that data reported here may differ from levels assessed using information about dispensed medicines. All informants were asked about the prescribed medicines currently being used. Young women aged 16 and over were also asked about contraceptive use as part of the self-completion questionnaire. 7.11.2 Use of prescribed medicines by age and sex Overall, 20% of boys and 19% girls reported using at least one prescribed medicine, with 10% of boys and girls reporting two or more. Among young adults, 18% of men and 26% of women reported using a prescribed medicine, with 8% of men and 14% of women using two or more. Among young adults, women were significantly more likely than men to be using a prescribed medicine, however, prescribed medicines recorded included the contraceptive pill. There was no clear pattern of medicine use with age. Table 7.65 7.11.3 Use of prescribed medicine by type The most common type of medicine was respiratory medicine which was used by approximately a tenth of children and young adults (12% of boys and 11% of girls; 9% of young men and 9% of young women). A small proportion of children and young adults reported using other medicines, with less than 2% of children and 5% of young adults using any other type of medicine. Table 7.66 7.11.4 Use of contraceptive pill among women aged 16-24 Overall, 54% of women aged 16-24 reported using the contraceptive pill. Of those who used this form of contraception, the majority (70%) used the combined pill whilst 17% had an injection, 11% used the mini-pill and 2% had an implant (Norplant). The injection was more common among younger women, 25% of those aged 16 who reported using the contraceptive pill used this method compared with 13% of those aged 24. Table 7.67
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