NATIONAL

HEALTH BEHAVIOUR IN SCHOOL-AGED CHILDREN:
WHO COLLABORATIVE CROSS-NATIONAL STUDY (HBSC)
2014 SURVEY IN SCOTLAND NATIONAL REPORT
WELL-BEING
INTRODUCTION
Mortality and morbidity are limited indicators of adolescent health due to low rates of death and serious illness during this
time 1 . Consequently, measures of subjective well-being take on particular importance during this life period. Self-appraisal
of adolescent health is informed by an overall sense of functioning, which includes both physical and non-physical aspects
of health 2 . Adolescence is a critical period of physical and emotional development with long-term impact on well-being
and health. Positive physical and emotional well-being can facilitate young people to tackle the numerous challenges they
face during adolescence 3,4 .
Subjective health complaints can be common during this time, and may include both psychological (e.g. irritability or
nervousness) and somatic symptoms (e.g. backaches or headaches) 5 . Symptoms can cluster, meaning that adolescents show
a high prevalence of multiple health complaints 6,7 , which may be associated with health problems during adulthood 8,9,10 .
Important protective factors for positive mental health and life satisfaction include school connectedness, and familial
social support and communication from at least one adult carer 11 . Supportive peer relations also protect against depression
and isolation 12 , and contribute to self-esteem by helping young people overcome the challenges and stresses associated
with adolescence 13,14 .
Mental and emotional health problems during adolescence have been linked with poor diet 15 , lack of exercise 16 , eating
disorders 17 , substance abuse 18 and a weakened immune system 19 , which may contribute to physical health problems.
Moreover, stress during adolescence has been associated with various health determinants and outcomes including
neighbourhood disadvantage 20 , school connectedness and teacher support 21 , dysfunctional body image 22 and tobacco
use 23 . Poor subjective health during adolescence has also been linked with depression, anxiety and sleep problems which
may extend to adulthood 24 , as well as negative school experiences, academic performance and absenteeism 25,26,27 .
Adolescent mental well-being and subjective health are related to socio-economic inequalities, gender differences 28
and geographic location 29 . Subjective health is also negatively related to medicine use 30 , which is commonly taken by
young people for ailments including headache, sleep difficulties, nervousness and stomachache 31,32,33 . Medicine use during
adolescence may then continue into adulthood 34.
The Getting It Right For Every Child (GIRFEC) 35 initiative is the Scottish Government approach to improving services to support
holistic well-being in young people. The approach encourages early intervention, and is the basis for the Curriculum for
Excellence 36 and the Children and Young People (Scotland) Act 2014 37 . Moreover, NHS Scotland has established a set of national
mental health indicators for children and young people, which cover both mental health and contextual factors 38,39 . This
will enable the development of a national mental health profile for children and young people in Scotland.
HBSC FINDINGS
The HBSC survey collects several indicators of young people’s physical and mental well-being. These include life satisfaction,
happiness, self-confidence, feeling left out, self-rated health, medicine use and the frequency of somatic and psychological
symptoms. Since 2006, HBSC has also administered the Kidscreen 40 scale, which is an instrument measuring healthrelated
quality of life. In 2014, Kidscreen was completed by 15-year old pupils only. HBSC also introduced a measure of
psychological stress among 13- and 15-year olds in 2014 41 .
LIFE SATISFACTION
Young people scored their life satisfaction using the Cantril Ladder (adapted version for children) 42 . A picture of a ladder
was shown with a description and question (see Appendix). A score of six or greater (on a scale of 0-10) was defined as
high life satisfaction. Eighty seven percent (87%) of young people are highly satisfied with their life (90% of boys; 84% of
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