MENTAL HEALTH: STRESS

y The nature and extent of STRESS and it s implication for young peoples health.

 Adolescence is a time of change and new challenges, hence young people can experience stress. Stress can be positive in that it motivates individuals to grow and develop into adulthood yet it can make young people vulnerable.  Young people are often insecure, confused and anxious and this is normal. However, problems can arise such as depression, psychosis, self harm and suicide when an individual has difficulty in dealing with stress.  The way a young person looks at life and reacts to stress will affect their ability to cope. Young people need to develop personal coping skills and alter their perspective of stress that affects them.  The human body responds to events that provoke stress (stressors) by activating the nervous system and specific hormones. The hypothalamus signals the adrenal glands to produce more of the hormones adrenaline and cortisol and release them into the bloodstream. These hormones speed up heart rate, breathing rate, blood pressure, and metabolism. The physical changes prepare you to react quickly and effectively to handle the pressure of the moment.  This natural reaction is known as the stress response. Working properly, the body's stress response improves your ability to perform well under pressure  There are many events that can be categorised as stressful. Examples of these are being involved in or witnessing an accident, being a victim of or witnessing abuse or violence, or losing someone close to you. Any stressful event can have an influence on how you feel emotionally.  After a stressful event it is normal to feel some stress, anxiety, sadness or to be afraid and it can take time for you to adjust to a lifestyle you are comfortable with again.  If your experience causes you to have flashbacks of the event, have bad dreams, lose your of appetite, lack sleep or become distant from day to day activities you may want to consult your doctor or a counsellor. Check out the Who can help you section for more information about what these people can do for you.  It is important that you deal with the feelings and reactions you are having so that they don't become overwhelming. Here are some things that may be helpful:  1. Paint it! - This is an another way of letting go of your feelings. Here you can draw a picture or image, which may help to express what is going on for you.  2. Keeping a diary - It may help to keep a diary where you can write down your feelings, as well as anything else that you wish to write about.  3. Talking to someone - Sometimes bottling your thoughts inside you can make the reactions worse. It may be helpful to talk to a friend or family member about the event and what you are feeling. It may also be helpful for you to share your feelings with someone who was involved in the event.  4. Seeking help - Your local doctor, clinical psychologist, counsellor or youth worker will be able to help you with strategies to cope with your feelings and reactions. If things are really bad and if appropriate then they can give you medication, which will assist in calming you. Check out the Who can help you section for more information on what these services can do for you.

 What's going on?

 What can I do?

http://raisingchildren.net.au/articles/anxiety_teenagers.html?s_kwcid=TC|14513 |stress%20in%20teen||S|b|7972315771&gclid=CNil_auKtakCFU6DpAod4D37RQ What is anxiety?

Everybody feels anxious sometimes, especially when faced with unfamiliar, dangerous or stressful situations. Anxiety can include butterflies, a sinking feeling, tense or uncomfortable feelings, or nerves. Its a normal reaction to challenging situations. Adolescent anxiety As children become teenagers, their boundaries expand. They have new challenges and opportunities. They want more independence. And their brains change. Because of all these changes, adolescence can be a particularly anxious time. For example, young people might worry about starting high school, how they look, fitting in with friends, sitting an exam, performing in a play at school, or even irrational concerns about a parent dying. As their independence increases, they might worry about being responsible for their own actions and getting a job. For most young people, anxiety is part of the normal range of emotions. Its usually just temporary and goes away on its own.
Anxiety isnt always a bad thing. Feelings of anxiety can help to keep young people safe by getting them to think about the situation theyre in. Anxiety can also be a helpful tool for motivating teenagers to do their best. It can help them get ready for challenging situations like public speaking or sporting events.

Helping young people manage anxiety

Learning to manage anxiety is an important life skill. If your child shows signs of anxiety, you can offer support in several ways:

Acknowledge your childs fear dont dismiss or ignore it. Its important for teenagers to feel that you believe they can overcome their fears. They also need to know that youll be there to support them. Let your child know that anxiety is normal. Tell your child about your own worries as a teenager, and remind your child that lots of other young people feel anxious too. Be a good role model for your child in the way that you manage your own stress and anxiety. You can read more about stress management in our article on feeling stressed. Gently encourage your child to do the things shes anxious about. But dont push her to face situations she doesnt want to face. You can also wait until your child actually gets anxious before you step in to help. Consider setting your child small goals in relation to things that make him anxious. Provide plenty of support and encouragement. For example, your child might be anxious about performing in front of others. As a first step, you could suggest your child practises his lines in front of the family, or works as a stagehand for the school play. Support your child in facing her fears. Acknowledge all the steps that she takes, no matter how small those steps are. Avoid labelling your child as shy or anxious. If your child avoids a situation because of anxiety, dont make a fuss. Let your child know that you believe he will be able to manage anxieties in the future. If your child has trouble talking about anxious feelings, suggest a diary or journal. It could help your child to write down thoughts and feelings. Spend time with people your child likes, trusts and feels comfortable around. Encourage a healthy lifestyle for your child, with plenty of physical activity, sleep and healthy food and drink. Its also important for your child to avoid drugs, alcohol and unnecessary stress.

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Make time in your family routine for things that your child enjoys and finds relaxing. These could be simple things like playing or listening to music, reading books or going for walks.

Getting help for anxiety

If you think your child needs help coping with anxiety, seek professional guidance as early as possible. You might feel uncomfortable talking to your child about anxiety or other mental health problems. By talking about anxiety with your child, you give her permission to talk to you. Your child also needs your help to access the necessary professional support. Options for help and support include:

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school counsellors or guidance counsellors your GP sometimes teenagers are more comfortable talking to a doctor who doesnt also see their parents, a younger doctor or a doctor of the same gender telephone parenting hotlines or Lifeline (13 11 14) your local community health centre local mental health services our mental health links and resources page the youthbeyondblue get help page.

If youre unsure where to go, your GP can guide you to the most appropriate services for your family.
Your child might not want to talk to you about how hes feeling. He might even say theres nothing wrong. If so, you could suggest a confidential telephone counselling service for young people, such as Kids Helpline (1800 55 1800). Your child could also visit the Kids Helpline website.

Anxiety problems and disorders

Most normal anxiety is short-lived perhaps a day or a few hours. An anxiety problem is when anxious feelings:

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are very intense go on for weeks, months or even longer get in the way of a young persons ability to learn, socialise and do things necessary for development.

An anxiety problem could be diagnosed by a health professional as an anxiety disorder. An anxiety disorder is a mental health problem.

The significance of the health issue based on three articles from Australian newspapers or print media.

http://www.smh.com.au/news/national/stress-hits-younger-generationhardest/2005/09/14/1126377375931.html

1. Stress hits younger generation hardest

By Julie Robotham Medical Editor September 15, 2005

Women suffer their highest rates of stress in their 20s. Then it gradually declines over the course of their lives, shrinking to negligible levels for most women by the time they are in their 70s.

"Older women have very high levels of mental health and general satisfaction with life, despite the fact they're often sick," said Christina Lee, the co-ordinator of the Australian Longitudinal Study on Women's Health, from which key results were released yesterday. "I wonder, is my generation and the younger generation going to be like that too? Are we going to turn into our grandmothers?" Studying was overwhelmingly the largest factor in young women's levels of stress, which they experienced at four times the rate of the oldest in the study of 40,000 women, Professor Lee said. The researchers found stress was highest among students and lowest among new mothers. Marriage and motherhood during the 20s were "expected, positive and normal changes" that despite their momentousness were easily introduced into women's lives - perhaps because of community support for them. By contrast, women who perceived their lives as moving backwards during their 20s - if they divorced, lost a job, or had to move back to their parents' home - found adjustment especially hard. "There's this notion of life transitions being on time or off time," she said. Louise Newman, the director of the NSW Institute of Psychiatry, said, "Significant life events are the things that give structure to people's lives. They're understood in our culture and mark a progression." She said the current generation of people in their 20s had questioned traditional roles more than previous generations, which made it harder to create their own "sense of meaning and connection". The survey results were consistent with other recent findings suggesting young people were swinging back towards conservatism. The survey also revealed the vast majority of Australian women were drinking alcohol in healthy quantities. Fewer than 5 per cent of women in any group drink at total levels regarded as risky according to health guidelines, while frequent binge-drinking among one in five young women rapidly tails off. "We were quite heartened that even among the older women a few drinks a day is associated with good health," Professor Lee said. "Our feeling from our data is that alcohol is not a major health problem for Australian women."

2. Mental illness ravaging nation's youth

Jill Stark
October 24, 2008 ALARMING new figures have revealed that one in four young people are battling a mental illness, with many problems triggered by drug and alcohol abuse. The first snapshot of Australia's mental health in a decade found that Generation Y is being ravaged by depression, anxiety disorders and substance abuse. Australian Bureau of Statistics data reveals that 26% of people aged 16 to 24 about 650,000 people suffered mental illnesses last year. Anxiety problems including panic attacks, obsessive compulsive disorder and post-traumatic stress were the most common with 15% of young people affected. Around 13% suffered conditions related to dependency on alcohol or other drugs such as sleeping pills, amphetamines and heroin. A further 7% had mood illnesses such as depression and bipolar. The figures come after a summit of leading mental health experts last week declared a "state of emergency" in youth mental health. They said young Australians with mental disorders, many of which develop in adolescence, were at greater risk of suicide, self-harm and drug addiction because of gaps in treatment.

The new figures come from face-to-face interviews with almost 9000 Australians aged 16 to 85, using World Health Organisation diagnostic tools. Professor Pat McGorry, head of the Orygen Research Centre and one of Australia's leading experts on youth mental health, said the figures had not improved in 10 years, suggesting a systemic failure in treatment. He said far greater levels of family breakdown than in previous generations were causing significant emotional turmoil for young people. Parents often did not recognise that a teenage mood swing could be a sign of something more serious. And many young people suffered in silence, unaware that their distress was not normal. "This is a national emergency, it's a huge, big public health problem," said Professor McGorry. "But I'm not sure the sense of urgency from Governments is as great as the need. "I don't think they realise how much investment and political support is needed to address this. Without it I think we're going to see continuing deterioration. Imagine if there was increased level of heart disease or cancer but the service system was not responding to it; there would be an outcry." Professor McGorry warned parents that the ABS figures could be an underestimate. "These are annual prevalence figures so that's just a one-year snapshot, whereas cumulatively, by the time they get to 25, the risk is even higher. "Everyone who's got a teenage kid must realise that they have got a one-in-three chance of developing a significant mental health problem by the age of 25," he said. Despite the huge demand for help, more than 2 million people did not receive appropriate treatment. David Crosbie, chief executive of the Mental Health Council of Australia, found the findings "startling". "Ten years ago around 38% of people (with mental illnesses) were getting services, now it's about 35%, so things are getting worse," he said. "Mental health is really the Cinderella of the health system it's just not treated as seriously." http://www.smh.com.au/lifestyle/wellbeing/mental-illness-ravaging-nations-youth-200904039mvp.html 3. 4. 5. 6. 7. 8. 9. Read more: http://www.smh.com.au/lifestyle/wellbeing/mental-illness-ravaging-nations-youth-200904039mvp.html#ixzz1PF9E4Eyn http://www.smh.com.au/lifestyle/wellbeing/dark-clouds-on-a-clear-day-20091111-ia0i.html http://www.smh.com.au/lifestyle/wellbeing/anxious-times-as-common-as-a-cold-20101008-16ate.html !!!! http://www.smh.com.au/articles/2003/12/11/1071086175516.html?from=storyrhs http://www.telegraph.co.uk/health/healthnews/4141649/Teenagers-turn-to-alcohol-and-drugs-to-copewith-school-stress.html http://www.dailytelegraph.com.au/news/opinion/stress-not-unique-to-teens/story-e6frezz01225958746605

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A campaign on anxiety to raise awareness about the health issue within your local community. Include promotion of current services and support available to young people The potential benefits of your proposed campaign for the health of young people.

As part of a school health programme, school mental health and social services can play a critical role in fostering healthy social and emotional development among students. To help students develop positive mental health, school mental health and social services can teach life-skills such as problem-solving, critical thinking, communication, interpersonal relations, empathy, and methods to cope with emotions and crises. In addition, school mental health and social services can include prevention, assessment, treatment, and case management for students either directly or

through referrals to community-based programs.

http://www.headspace.org.au/media/150419/hints%20to%20avoid%20harmful%20stress.pdf http://www.aihw.gov.au/publication-detail/?id=6442467534

Mental health is .a state of successful performance of mental function. which allows people to undertake productive activities, experience meaningful interpersonal relationships, adapt to change and cope with adversity (USDHHS 1999: 4). Mental health is important for cognitive and communication skills, learning, personal development, resilience and self-esteem. It can be difficult to narrowly define mental health, as it is a subjective state that can vary across cultures and among subgroups. However, it is much easier to define and also to examine mental ill health, which may be manifested along a spectrum including psychological distress, mental health problems and clinical disorders. Mental disorders are characterised by a clinically significant set of symptoms, as set out in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (APA 1994; Sawyer et al. 2000). Mental disorders have clear diagnostic criteria that must be met for a disorder to be diagnosed, including that the symptoms cause clinically significant impairment in social, academic or occupational functioning. Young people may experience both mental health problems and mental disorders. Mental health problems are defined at a lower threshold of symptoms than mental disorders. Mental health problems are much more common than mental disorders, and also affect social and other functioning. They may be manifested as disturbance of feelings, behaviours and thoughts, and can have features, which are similar to those experienced by people with mental disorders, such as somatic complaints, attention problems and feelings of anxiety or depression. Risk factors for mental ill health can include both biological factors and adverse psychosocial experiences during childhood (USDHHS 1999). It has been suggested that some people may have a genetic vulnerability to certain disorders, but that these disorders will not develop in the absence of other risk factors. There are many risk factors which have been associated with a higher likelihood of developing a mental illness, but this does not mean that these factors cause mental illness, or that everyone who is exposed to them will develop a mental disorder. Risk factors may include factors associated with the individual (e.g. prenatal brain damage, poor social skills, low self-esteem), family or social factors (e.g. marital discord between parents, parental mental disorder, parental alcoholism or drug addiction, social isolation), school context (e.g. bullying, failure to achieve academically), life events and situations (e.g. physical, sexual and emotional abuse, physical illness or impairment, poverty) and community and cultural factors (e.g. socioeconomic disadvantage, social or cultural discrimination) (DHAC 2000a). Many mental health problems and disorders can have their origins in childhood, when exposure to many risk factors for mental illness can occur. Also, many mental health problems are first manifested in childhood and adolescence. Psychosocial problems that can be associated with child mental health problems may in turn play a part in the development of mental disorders in young people, through mechanisms such as lowered self-esteem and lack of social support. Mental disorders which have their onset in childhood and adolescence include anxiety disorders, attention-deficit and disruptive behaviour disorders, autism and other pervasive developmental disorders, eating disorders, learning and communication disorders, mood disorders, schizophrenia and tic disorders (USDHHS 1999). Substance use disorders can also arise in adolescence, and frequently co-occur with other mental disorders. Young people who are experiencing mental health problems and disorders are at

considerably increased risk of poor health and wellbeing outcomes. Mental health problems and disorders can affect people.s ability to undertake their usual activities and responsibilities, such as schooling, working and socialising. Mental health problems and disorders can lead to increased substance use, poor relationships, Australia.s young people 2003 90 increased delinquency and antisocial behaviours, poor self-esteem, and other mental health problems. Beautrais (2000) suggests that the strongest risk factors for youth suicide are mental disorders (particularly affective disorders, substance use disorders and antisocial behaviours) and a history of psychopathology. Young people who have substance use problems are also at increased risk of premature death, particularly from overdose. Because of its enormous social and public health importance, mental health is one of the six National Health Priority Areas (AIHW & DHFS 1997). A number of public health strategies have been implemented to try to combat mental health problems and disorders, including the National Mental Health Strategy, the National Drug Strategy Action Plan and the National Suicide Prevention Strategy. This chapter presents data on psychological distress among young people aged 18.24 years followed by an examination of mental health problems experienced by young people aged 12.17 years, and mental disorders experienced by people aged 12.17 and 18.24 years. It also focuses on substance use disorders, suicide and intentional self-harm. Prevalence data on psychological distress come from the National Survey of Mental Health and Wellbeing for 1997 and the ABS NHS for 2001. Prevalence data on mental health problems and disorders among those aged 12.17 years come from the Child and Adolescent Component of the National Survey of Mental Health and Wellbeing, conducted in 1998. Prevalence data on mental disorders among those aged 18.24 years come from the National Survey of Mental Health and Wellbeing, conducted in 1997. These two surveys were conducted separately using different survey instruments, and thus data are not comparable.

Psychological distress
Psychological distress refers to an individual.s overall level of psychological strain or pain, evidenced by psychological states such as depression, anxiety and anger. Psychological distress may be fairly transient, e.g. experiencing high anxiety over an upcoming exam, or sadness because of the break-up of a relationship, but may also be a continuing problem, particularly among those experiencing mental health problems and clinical disorders. Psychological distress can be measured using the Kessler-10 distress scale, or K10. The K10 contains 10 items asking about feelings such as nervousness, hopelessness, restlessness, depression and worthlessness. For each item, the respondents are asked how often they experienced these feelings in the past 4 weeks, with responses ranging from .none of the time. to .all of the time. (scoring 1 to 5). The maximum score is 50 (indicating severe distress) and the minimum score is 10 (no distress). Andrews and Slade (2001) showed a strong association between the K10 scale and current diagnoses of anxiety and affective disorders. They also showed a lesser, but significant, association with other mental disorder categories. The K10 scores from the National Survey of Mental Health and Wellbeing for young people aged 18.24 years are presented in Figure 8.1. A K10 score of 10.15 indicates a low level of distress, 16.21 a medium level, 22.29 a high level, and 30.50 a very high level. People who score 16.30 have three times the population risk of having a current anxiety or depressive disorder (25% chance) or of ever having attempted suicide (1% chance) (Andrews 2003). People who score 30.50 have ten times the population risk 91 Mental health problems and disorders

of meeting criteria for an anxiety or depressive disorder (75% chance), and 20 times the population risk of ever having attempted suicide (6% chance) (Andrews 2003). . In 1997, 0.6% of males and 1.9% of females aged 18.24 years reported very high levels of distress. In 2001, these proportions were 2.7% and 5.4%, respectively. . In both 1997 and 2001, over half of young people aged 18.24 years had a low level of psychological distress (66% and 54%, respectively). . In both years, a higher proportion of males had a low level of psychological distress, and a higher proportion of females had moderate, high and very high levels of psychological distress. Data from the ABS NHS show that high levels of psychological distress in young people are more likely to be associated with poor educational and employment outcomes. The highest levels of psychological distress were found among young people whose highest year of school completed was Year 9. The lowest levels were among young people whose highest year of school completed was Year 12. A higher proportion of unemployed young people had very high K10 scores compared with other young people. Psychological wellbeing is also associated with physical health problems. The psychological distress scores of young people aged 18.24 years with and without longterm conditions are shown in Figure 8.2.
Source: 1997 National Survey of Mental Health and Wellbeing; ABS NHS 2001.

Figure 8.1: K10 scores for young people aged 18.24 years, 1997 and 2001

Australia.s young people 2003 92 . Around 5% of young people aged 18.24 years with long-term conditions reported very high psychological distress, and around 50% with long-term conditions reported low levels of psychological distress. . Of those with no long-term conditions, 1% reported very high levels of psychological distress and around two-thirds reported low levels of psychological distress. Levels of psychological distress can also vary with different numbers of long-term conditions. Whereas 68% of those with no long-term conditions had low levels of psychological distress, this decreased to 61% of those with one long-term condition, 50% of those with two long-term conditions, and 33% of those with three or more long-term conditions. Conversely, 1% of those with no long-term conditions or one long-term condition, 3% with two long-term conditions and 11% of those with three or more long-term conditions had very high levels of psychological distress.
Source: ABS NHS 2001.

Figure 8.2: K10 scores for young people aged 18.24 years, by existence of long-term condition, 2001

93 Mental health problems and disorders

Prevalence of mental health problems

The Child Behaviour Checklist and the Youth Self-Report were used in the Child and Adolescent Component of the National Survey of Mental Health and Wellbeing to examine the prevalence of emotional and behavioural problems in children aged 4.17 years. Sawyer et al. (2000) considered children and adolescents to have mental health problems when they were experiencing a number of emotional and behavioural problems in the range typically seen in children and adolescents attending mental health clinics. Two types of mental health problems were examined: internalising problems (inhibited or over-controlled behaviours, such as anxiety or depression) and externalising problems (antisocial or under-controlled behaviours, such as delinquency or overt aggression). Data based on parent-report alone are presented for young people aged 12.17 years in Table 8.1.
Table 8.1: Prevalence of mental health problems among young people aged 12.17 years, 1998
Note: Problem areas are not mutually exclusive, and thus .total problems. do not equal the sum of internalising and externalising problems.

Source: 1998 National Survey of Mental Health and Wellbeing, Child and Adolescent Component, unpublished data.

. In 1998, 14% of young people aged 12.17 years (an estimated 217,000) had a mental health problem. . Approximately equal numbers of young people were assessed as having externalising problems or internalising problems (13% and 12% respectively). . The prevalence of internalising problems was higher for males than for females, and the prevalence of externalising problems was similar among males and females. The most prevalent specific mental health problems were somatic complaints, affecting 9% of young people aged 12.17 years. Delinquent behaviour was next most common (6%), followed by attention problems and aggressive behaviour (around 5%).
Males Females Persons Per cent Population estimate (.000) Per cent Population estimate (.000) Per cent Population estimate (.000) Internalising 14.7 121 10.3 81 12.4 202 Externalising 12.3 101 13.8 108 13.1 209 Total problems 14.9 122 12.1 95 13.5 217

Australia.s young people 2003 94

Prevalence of mental disorders

Young people aged 12.17 years
The Child and Adolescent Component of the National Survey of Mental Health and Wellbeing examined the prevalence of three mental disorders among children and adolescents aged 6.17 years: depressive disorder, conduct disorder and attention-deficit hyperactivity disorder (ADHD). The Diagnostic Interview Schedule for Children (Version IV) (Shaffer et al. 2000, cited in Sawyer et al. 2000) was used. This Schedule uses the diagnostic criteria described in the DSM-IV. Anxiety disorders were not included in the survey, despite their relatively common prevalence among young people (see Sawyer et al. 2000).
Table 8.2: Prevalence of mental disorders among young people aged 12.17 years, 1998
(a) The high proportion of young people with ADHD could be influenced by diagnostic definitions of ADHD. Note: Disorders such as ADHD, conduct disorder and depressive disorder are not mutually exclusive, and thus the .total. does not equal the sum of listed disorders. Source: 1998 National Survey of Mental Health and Wellbeing, Child and Adolescent Component, unpublished data.

. Around 12% of young people aged 12.17 years (or 193,000 young people) were assessed as having ADHD, conduct disorder or depressive disorder in 1998. ADHD was the most prevalent (8%), followed by depressive disorder (4%) and conduct disorder (3%). . The prevalence of ADHD was assessed to be higher in males than females (12%, compared with 4%). . Conduct disorder was also more prevalent among males (4%) than females (1%). . The prevalence of depressive disorder among males and females was the same (4%). The majority of adolescents surveyed (89%) were assessed as not having ADHD, conduct disorder or depressive disorder. However, of those with a mental disorder, some had more than one disorder. The comorbidity of ADHD, depressive disorder and conduct disorder is shown in Figure 8.3.
Males Females Persons Per cent Population estimate (.000) Per cent Population estimate (.000) Per cent Population estimate (.000) ADHD(a) 12.3 101 3.8 30 7.9 131 Conduct disorder 4.1 34 1.1 9 2.6 43

Depressive disorder 4.0 32 4.1 32 4.1 65 Total 16.1 132 7.8 61 11.9 193

95 Mental health problems and disorders . Of young people aged 12.17 years with a mental disorder, 49% were assessed as having ADHD only, 23% depression only, and 7% conduct disorder only. . Some young people had two mental disorders: 9% were assessed as having ADHD and conduct disorder, 4% ADHD and depression, and 3% depression and conduct disorder. . A small proportion of those with a mental disorder (5%) were assessed as having ADHD, depression and conduct disorder.
Source: 1997 National Survey of Mental Health and Wellbeing; Child and Adolescent Component, unpublished data.

Figure 8.3: Comorbidity of ADHD, conduct disorder and depressive disorder among young people aged 12.17 years with a mental disorder, 1998

Australia.s young people 2003 96

Young people aged 18.24 years

The prevalence of certain mental disorders among young people aged 18.24 years was assessed in the National Survey of Mental Health and Wellbeing. This survey used the Composite International Diagnostic Interview (CIDI) to diagnose certain mental disorders. In particular, anxiety disorders, depressive disorders, and alcohol and drug use disorders were looked at in this survey.
Table 8.3: Prevalence of mental disorders among young people aged 18.24 years, 1997
(a) Total anxiety, affective and substance use disorders only. Total is not cumulative as categories are not mutually exclusive. Source: AIHW analysis of ABS 1997 National Survey of Mental Health and Wellbeing confidentialised unit record file.

. Among young people aged 18.24 years, 27% of males and 26% of females were assessed as having a mental disorder (over 481,000 young people). . Substance use disorders were the most prevalent, affecting about 1 in 5 males and 1 in 10 females. Alcohol dependence was the most prevalent substance use disorder, affecting 12% of males and 4% of females. . Anxiety disorders affected 8% of males and 14% of females. Within the group of anxiety disorders, post-traumatic stress disorder was the most prevalent, affecting 5% of young people. . Depression and dysthymia (chronic mild depression) affected 3% of males and 11% of females. Experiencing a mental disorder can affect educational outcomes and participation in employment. For example, data from the National Survey of Mental Health and Wellbeing show that a higher prevalence of mental disorders occurred among young people who had not completed secondary education (35%) than among those who had
Males Females Persons Mental disorders Per cent Population estimate (.000) Per cent Population estimate (000) Per cent Population estimate (000) Anxiety disorders Panic disorder 0.2 1.9 1.3 11.3 0.7 13.2 Agoraphobia 0.8 7.3 1.7 15.0 1.2 22.3 Social phobia 4.1 37.8 4.7 42.6 4.4 80.3 Generalised anxiety disorder 1.2 11.3 2.1 18.6 1.6 29.9 Obsessive.compulsive disorder 0.4 3.5 0.7 6.1 0.5 9.6 Post-traumatic stress disorder 3.4 30.9 6.8 61.0 5.1 91.9 Total anxiety disorders 8.3 76.5 13.8 123.8 11.0 200.3 Affective disorders Depression 2.7 24.6 10.2 91.6 6.4 116.2 Dysthymia 0.3 2.5 0.8 7.4 0.5 9.9 Total affective disorders 2.9 26.4 10.8 97.1 6.8 123.5 Substance use disorders

Alcohol harmful use 4.4 40.4 4.0 35.6 4.2 76.0 Alcohol dependence 12.0 110.2 4.3 38.3 8.2 148.6 Drug use disorders 9.2 85.1 3.6 32.0 6.4 117.1 Total substance use disorders 21.2 194.8 10.5 94.4 15.9 289.2 Total mental disorders(a) 27.1 249.4 25.9 232.2 26.5 481.6 No mental disorders 72.9 671.2 74.1 664.3 73.5 1,335.5 Total persons (000) 100.0 920.6 100.0 896.5 100.0 1,817.1

97 Mental health problems and disorders post-school qualifications or who had completed secondary school (just under 25%). Unemployed young people and those not in the labour force were also more likely to suffer from a mental disorder than other young people. Anxiety disorders and substance use disorders were most prevalent among young unemployed people and depressive disorders were more prevalent among young people not in the labour force.

Hospitalisations
A range of services provide support for young people with mental health problems or disorders. These include school or university counsellors, general practitioners, psychologists, social workers, psychiatrists and public mental health services (community-based and hospital services). The National Survey of Mental Health and Wellbeing found that, for all people with a mental disorder, the service most frequently used was general practitioners. The Child and Adolescent Component of the same survey found that the two services used most commonly by adolescents with a mental disorder were school counselling and family doctors. Young people with mental disorders may be hospitalised if mental disorders are poorly managed, if a young person has hurt or threatened to hurt themselves or others, or if they are experiencing an acute phase of a moderate to severe psychiatric illness. Hospitalisation rates for young people aged 12.24 years for mental and behavioural disorders are presented only from 1996.97 onwards. Before this time, public psychiatric hospitals were not fully included in the AIHW National Hospital Morbidity Database. Australia.s young people 2003 98 . Hospitalisations of young people for mental and behavioural disorders increased by 28% between 1996.97 and 2000.01, from 988 to 1,2651 hospitalisations per 100,000 young people. The rate of hospitalisations declined after 1999.00. . Over this period, hospitalisation rates were similar for males and females, but females had slightly higher rates for all years.
Note: ICD-9-CM codes 290.316 (1996.97 and 1997.98) and ICD-10-AM codes F00.F99 (excluding F70.F79) (1998.99 onwards). Source: AIHW National Hospital Morbidity Database.

Figure 8.4: Mental and behavioural disorder hospitalisation rates for young people aged 12.24 years, 1996.97 to 2000.01

99 Mental health problems and disorders Mental and behavioural disorder hospitalisation rates by age groups are shown in Figure 8.5. . In 2000.01, there were over 43,000 hospitalisations of young people for mental and behavioural disorders. This was a rate of around 1,265 hospitalisations per 100,000 young people. . In the age groups 12.14 years and 18.24 years, males and females were hospitalised at similar rates. In the age group 15.17 years, females were hospitalised at a rate 1.5 times that for males. . Hospitalisation rates increased with age. Rates for young people aged 18.24 years were over 3 times those for young people aged 12.14 years.

Hospitalisations for specific diagnoses

Hospitalisation rates for the 10 most frequent mental and behavioural disorder diagnosis groups are shown in Figure 8.6. In 2000.01, these 10 most frequent groups accounted for 73% of all hospitalisations for mental and behavioural disorders among

young people aged 12.24 years.

Note: ICD-10-AM codes F00.F99 (excluding F70.F79). Source: AIHW National Hospital Morbidity Database.

Figure 8.5: Mental and behavioural disorder hospitalisation rates for young people aged 12.24 years, 2000.01
1,800 1,600 1,400 1,200 1,000 800 600 400 200 0

Australia.s young people 2003 100 . For young people aged 12.24 years in 2000.01, the most frequent diagnosis groups resulting in hospitalisation for mental and behavioural disorders were depressive episode and schizophrenia. . The most frequent diagnosis groups for young women were depressive episode (232 hospitalisations per 100,000 young women, accounting for 17% of all mental and behavioural disorders) and eating disorders (213 per 100,000 young women, 16% of hospitalisations for all mental and behavioural disorders). Within the eating disorders diagnosis group, the most frequent diagnosis was anorexia nervosa. . The most frequent diagnosis groups for young men were schizophrenia (229 per 100,000 young men, 19% of all mental and behavioural disorders) and depressive episode (134 per 100,000 young men, 11% of hospitalisations for all mental and behavioural disorders). Within the schizophrenia diagnosis group, the most frequent diagnosis was paranoid schizophrenia. . The third most common diagnosis group among young people aged 12.24 was .reaction to severe stress, and adjustment disorders.. This group contains acute stress reaction, and post-traumatic stress disorder.
Note: ICD-10-AM codes F32, F20, F43, F50, F10, F11, F60, F33, F31 and F41. Source: AIHW National Hospital Morbidity Database.

Figure 8.6: Mental and behavioural hospitalisation rates for young people aged 12.24 years, most frequent disorder groups, 2000.01

101 Mental health problems and disorders

Deaths
In 2001, 34 deaths among young people aged 12.24 years were classified as being caused by mental and behavioural disorders.1 This accounted for 7% of all deaths in this age group. Of these 34 deaths, 28 were from mental and behavioural disorders due to psychoactive substance use, which are discussed in the following section on substance use disorders.