Schools and other educational institutions play a significant role in providing services to young
people with mental disorders and are sometimes where emotional and behavioural problems are first
identified.
This chapter provides an overview of the role played by teachers and other school staff in providing
support and other services, and referring young people with emotional and behavioural problems to
health service providers. The relationship between mental disorders and school attendance,
functioning at school and academic performance is also reported.
Data are presented for the 95.9% of young people participating in the survey who were either
attending school or another educational institution or had attended in the past 12 months and are
based on parent and carer reports. This includes children who were attending part-time or full-time
schooling prior to Year 1.
9.1 Identification of young people with emotional or behavioural problems
by school staff
Where parents had acknowledged that their child or adolescent had ever experienced emotional or
behavioural problems that were significant enough to need help, they were asked who it was that
thought that their child needed help including school staff.
Two fifths (40.5%) of parents and carers reported that a school staff member was among those to
suggest that their child may need help for emotional or behavioural problems. Just over a third
(35.6%) of parents and carers reported that a school teacher or principal was among those to suggest
that their child needed some help for emotional or behavioural problems and 12.0% said that either
the school counsellor, psychologist or nurse were among those to identify emotional or behavioural
problems in their child or adolescent (Table 9-1).
Table 9-1: Proportion of parents or carers who reported that their child’s emotional or behavioural
problems were identified by school staff
Staff member identifying problem
Students who have ever had emotional or
behavioural problems (%)
School teacher or principal 35.6
School counsellor, psychologist or nurse 12.0
Any school staff 40.5
9.2 School contact with families
One eighth (12.8%) of parents and carers had been contacted in the previous 12 months by the school
about a range of emotional or behavioural issues, including bullying (both as perpetrator or victim),
aggressive behaviour and conduct issues (Table 9-2).
90 The Mental Health of Children and Adolescents
It was more common that schools contacted families about emotional or behavioural issues when the
student was male (16.2%) rather than female (9.3%). It was also more common that families were
contacted by the school about emotional or behavioural issues when students were older (15.4% of
12-17 year-olds compared with 10.8% of 4-11 year-olds).
Contact by the school in respect of emotional or behavioural issues was over four times more
common for those students who were identified in the survey as having mental disorders (39.7%
compared to 8.3% of students without a disorder). The proportion contacted was higher for older
students (45.3%) with a mental disorder than younger students with mental disorders (35.4%). The
proportion was also higher for males with mental disorders (43.4%), than for females with mental
disorders (34.3%) especially in the 4-11 year-olds age group (40.2% of males compared with 27.6% of
females).
Table 9-2: School contact in past 12 months by sex, age group and mental disorder status
Sex
Age group
Mental
disorder (%)
No disorder
(%)
All students
(%)
Males 4-11 years 40.2 9.4 14.6
12-17 years 47.8 12.5 18.1
4-17 years 43.4 10.8 16.2
Females 4-11 years 27.6 4.2 6.8
12-17 years 41.9 8.3 12.5
4-17 years 34.3 6.0 9.3
Persons 4-11 years 35.4 6.7 10.8
12-17 years 45.3 10.4 15.4
4-17 years 39.7 8.3 12.8
9.3 Services used at school
Just over one in ten (11.5%) students had used a school service for emotional or behavioural
problems in the previous 12 months, with a higher proportion of older students (14.2% of 12-17 yearolds)
than younger students (9.4% of 4-11 year-olds) using services (Table 9-3).
Individual counselling was the most commonly used type of school service in the previous 12 months
(8.0% of students). Twice as many older students (11.0%) as younger students (5.6%) used individual
counselling services at school.
The Mental Health of Children and Adolescents 91
Table 9-3: School service use for emotional or behavioural problems in past 12 months among 4-17
year-olds by type of service and age group
Type of school service 4-11 years (%) 12-17 years (%) 4-17 years (%)
Individual counselling 5.6 11.0 8.0
Group counselling or support program 2.2 3.2 2.7
Special class or school 2.7 2.8 2.7
School nurse 0.8 2.0 1.4
Other school services 3.3 5.2 4.1
Any service at school 9.4 14.2 11.5
9.3.1 Referral from school to health service providers
When parents and carers reported that the child or adolescent had used the services of particular
health service providers in the previous 12 months for emotional or behavioural problems, they were
asked if the recommendation or advice to see the provider came from the school.
Of those children or adolescents who had seen a paediatrician, one quarter (25.3%) had been
recommended or advised to see the paediatrician by their school. About one in six children and
adolescents who used the services of a general practitioner, psychiatrist or psychologist in the
previous 12 months (15.8%, 17.0% and 16.9% respectively) had seen the health service provider
following recommendation or advice from the school (Table 9-4).
Table 9-4: Proportion of students using health services in past 12 months who were referred by their
school by provider type
Health service provider All students (%)
General practitioner 15.8
Paediatrician 25.3
Psychiatrist 17.0
Psychologist 16.9
Any health service provider 22.6
9.4 Informal support from teachers and other school staff
One in five students (18.9%) had received informal support for emotional or behavioural problems
from a school staff member in the previous 12 months. Of those that had received informal support
from school staff nearly three fifths (57.2%) had not used formal school services in the previous 12
months as reported in the previous section. One in six students (15.7%) had received informal support
from their teachers and one eighth (12.2%) had received informal support for emotional or
behavioural problems from other school staff (Table 9-5).
92 The Mental Health of Children and Adolescents
Informal support was around four times higher for young people with a mental disorder, with around
half of students with a mental disorder (51.0%) receiving informal support from their teacher and/or
other school staff in the previous 12 months compared with 13.6% of those without a mental disorder.
Table 9-5: Proportion of students receiving school-based informal support in past 12 months by
mental disorder status
Staff member providing support Mental disorder (%) No disorder (%) All students (%)
His or her teacher 43.2 11.4 15.7
Other school staff 38.6 7.9 12.2
Any school staff 51.0 13.6 18.9
9.5 Relationship between mental disorders and schooling
This section reports on the relationship between mental disorders and school-related outcomes,
including days absent from school, impact on functioning at school due to symptoms of mental
disorder, school performance in different learning areas and enjoyment of school.
9.5.1 Days absent from school
The average days absent from school due to symptoms of the mental disorder were greatest for those
with major depressive disorder and anxiety disorders (on average 20 and 12 days in the previous 12
months respectively). The days absent were far higher among older students for all disorders, with 12-
17 year-olds with major depressive disorder being absent 23 days and those with anxiety disorders
absent 20 days on average in the previous 12 months. Although adolescents with conduct disorder
did not have as many days absent from school, the difference between the two age groups was
greatest, with 12-17 year-olds absent 17 days and 4-11 year olds absent just 2 days on average in the
previous 12 months due to the symptoms of their disorder (Table 9-6).
Table 9-6: Average days absent in past 12 months due to symptoms of mental disorder by age group
and disorder type
Age group
Anxiety disorders
(days)
Major depressive
disorder (days) ADHD (days)
Conduct disorder
(days)
4-11 years 6 14 4 2
12-17 years 20 23 9 17
4-17 years 12 20 5 8
9.5.2 Impact on functioning at school
The level of impact on functioning at school varied with the type of mental disorder. The greatest
impact was due to symptoms of major depressive disorder, with this having had a severe impact on
school function for one third (34.3%) of students with this disorder. The symptoms of ADHD had the
least impact for most students, with this having mild impact on schooling for 40.0% of students. One
third (35.6%) of those with conduct disorder and 20.0% with anxiety disorders experienced no impact
on schooling according to parents and carers (Table 9-7).
The Mental Health of Children and Adolescents 93
The level of impact on schooling differed between the age groups for all types of mental disorders. In
particular, severe impact on functioning at school due to symptoms of anxiety or ADHD was more
common among 12-17 year-old students than 4-11 year-old students (29.1% compared with 12.6% for
anxiety disorders and 20.4% compared with 8.5% for ADHD). The greatest difference was for conduct
disorders, with the impact being severe for 22.8% of 12-17 year olds and moderate for another 43.6%
compared with 10.3% with severe impact and 11.0% with moderate impact for 4-11 year-olds.
Table 9-7: Impact on functioning at school in past 12 months among 4-17 year-olds with mental
disorders by age group and mental disorder type
Age group
Level of impact on
functioning
Anxiety
disorders (%)
Major
depressive
disorder (%) ADHD (%)
Conduct
disorder (%)
4-11 years None 27.1 np 16.9 46.2
Mild 36.9 15.7 42.2 26.7
Moderate 19.5 27.3 29.9 11.0
Severe 12.6 45.4 8.5 10.3
Does not go to school 4.0 np 2.6 np
12-17 years None 10.7 8.9 7.0 21.8
Mild 24.7 17.8 36.2 6.9
Moderate 29.9 36.1 33.2 43.6
Severe 29.1 30.8 20.4 22.8
Does not go to school 5.7 6.3 3.3 np
4-17 years None 20.0 9.6 13.3 35.6
Mild 31.7 17.3 40.0 18.1
Moderate 23.9 34.1 31.1 25.2
Severe 19.7 34.3 12.8 15.8
Does not go to school 4.7 4.8 2.8 5.4
np Not available for publication because of small cell size, but included in totals where applicable.
9.5.3 School performance by mental disorder status
Table 9-8 shows parent and carer ratings of students’ performance across five different learning areas
for those with and without a mental disorder. Given the different ages at which learning areas are
introduced, performance in Maths, English, Art and Sports is reported for children aged six and older,
and performance in Science is reported for children aged 11 and over.
School performance in all subjects was markedly poorer for those with a mental disorder. In particular
there was a greater difference in the core learning areas. In Maths 37.0% of students with mental
disorders were rated below average compared with 10.5% of those with no disorder. In English 39.4%
of students with mental disorders were rated below average compared with 10.8% of those with no
disorder. In Science 33.7% of students with mental disorders were rated below average compared
with 8.8% of those with no disorder. The same was true for Art and Sports learning areas, but the
differences were somewhat less.
94 The Mental Health of Children and Adolescents
Table 9-8: School performance in past 12 months by mental disorder status and school subject
Mental
disorder
status
Subject
Far above
average (%)
Somewhat
above
average (%) Average (%)
Somewhat
below
average (%)
Far below
average (%)
Any
disorder
Maths 9.1 18.3 35.6 24.5 12.5
English, reading or writing 12.2 19.1 29.2 25.0 14.4
Science 5.7 15.7 45.0 21.9 11.8
Art or drawing 11.2 26.2 44.3 12.7 5.6
Sports or physical education 14.3 23.5 38.8 16.0 7.3
No
disorder
Maths 17.1 33.5 38.8 9.0 1.5
English, reading or writing 20.2 33.8 35.2 9.3 1.5
Science 13.2 32.5 45.6 7.7 1.1
Art or drawing 15.2 34.6 43.9 5.3 1.0
Sports or physical education 21.5 30.7 38.9 7.7 1.2
Note: Performance in Maths, English, Art and Sports is reported for children aged six and older, while performance in Science
is reported for children aged 11 and over.
The survey also gathered data from parents and carers concerning how much their children liked
school. A higher proportion of children and adolescents with a mental disorder than those without
a mental disorder somewhat disliked or very much disliked school (21.6% compared with 5.1%)
(Table 9-9).
Table 9-9: Rating of how much students liked school in past 12 months by mental disorder status
Level of liking Mental disorder (%) No disorder (%) All students (%)
Very much likes school 31.3 59.3 55.3
Somewhat likes school 37.4 29.5 30.6
Neither likes nor dislikes school 9.7 6.1 6.6
Somewhat dislikes school 12.1 3.9 5.1
Very much dislikes school 9.5 1.2 2.4
PART 4
What adolescents
told us
Mental health problems, self-harm, suicidal
behaviours and risk behaviours based on
adolescents’ self-reported information
Adolescents aged 11-17 years were asked to complete a self-report
questionnaire on a tablet computer in the privacy of their own bedrooms.
The questionnaire had 12 modules, took 37 minutes on average to
complete, and was completed by 89% of the selected young people.
The questionnaire included the Diagnostic Interview Schedule for Children
Version IV (DISC-IV) major depressive disorder module, as well as
questions on services used for emotional or behavioural problems.
Additional modules were included about young people’s experiences at
school, family relationships, self-esteem, protective factors and a range
of risk behaviours as well as any self-harm and suicidality. Age cut-offs
were implemented for certain questions that were considered
inappropriate to ask younger adolescents.
All young people also completed the Kessler 10 Psychological Distress
Scale, a measure of psychological distress and the Strengths and
Difficulties Questionnaire, a brief behavioural screening questionnaire.
Comparison of responses with those from parents and carers highlights
the importance of collecting information from young people themselves.
96 The Mental Health of Children and Adolescents
The Mental Health of Children and Adolescents 97
10 MENTAL DISORDERS, SELF-REPORTED PROBLEMS
AND DISTRESS
The survey collected information about major depressive disorder in children and adolescents aged
4-17 years from parents and carers (see Chapter 3) and also from young people themselves aged 11-
17 years. The tool used for assessing major depressive disorder was the major depressive disorder
module from the Diagnostic Interview Schedule for Children Version IV (DISC-IV). This was included in
the adolescent self-report questionnaire for 11-17 year-olds, and the parent report version was given
to parents and carers. The information provided was used to determine whether a young person met
the diagnostic criteria for the disorder as described in the Diagnostic and Statistical Manual of Mental
Disorders Version IV (DSM-IV).
This chapter presents the prevalence of major depressive disorder determined on the basis of
adolescents’ responses to the DISC-IV module. Differences in the prevalence from the perspectives of
young people and parents and carers are also examined.
Further insight into young people’s mental health is provided by the Kessler 10 Psychological Distress
Scale (K10) and the Strengths and Difficulties Questionnaire (SDQ), which were also completed as part
of the adolescent self-report questionnaire.
10.1 Prevalence of major depressive disorder
Based on information from young people themselves, 7.7% of adolescents aged 11-17 years met the
diagnostic criteria for major depressive disorder. This is equivalent to an estimated 152,000
adolescents with major depressive disorder.
The prevalence of major depressive disorder was higher in females than males (11.0% compared with
4.5%), and higher in older adolescents (16-17 years) than younger adolescents (11-15 years). Some
8.2% of males aged 16-17 years met diagnostic criteria for major depressive disorder, compared with
3.1% of males aged 11-15 years. In females, 19.6% of 16-17 year-olds had major depressive disorder
compared with 7.2% of 11-15 year-olds (Table 10-1).
Table 10-1: Prevalence of major depressive disorder among 11-17 year-olds based on adolescent
report by sex and age group
Age group Males (%) Females (%) Persons (%)
11-15 years 3.1 7.2 5.0
16-17 years 8.2 19.6 14.0
11-17 years 4.5 11.0 7.7
10.2 Severity of impact on functioning of major depressive disorder
The severity of major depressive disorder in four different domains (school or work, friends and social
activities, family and self) and overall was assessed from young people directly using the same set of
98 The Mental Health of Children and Adolescents
questions that was administered to their parents and carers. Based on information from young
people themselves, one in three young people with major depressive disorder (34.2%) had severe
impact on functioning. Similar proportions of young people with major depressive disorder
experienced a severe level of impact in each of the four domains considered (Table 10-2).
Table 10-2: Severity of impact in different life domains among 11-17 year-olds with major depressive
disorder based on adolescent report
Severity School/work (%) Friends (%) Family (%) Self (%)
Overall
severity (%)
None 5.7 2.7 4.2 3.0
Mild 28.5 31.8 25.8 28.3 38.8
Moderate 35.7 36.3 40.6 41.0 27.0
Severe 25.5 29.3 29.5 27.7 34.2
Does not go to school or work 4.5
10.3 Comparison of prevalence of major depressive disorder based on
adolescent report with parent and carer report
The prevalence of major depressive disorder based on information provided by adolescents and that
based on information provided by parents and carers are presented in Table 10-3. Overall, the
prevalence of major depressive disorder was higher based on adolescent reported information (7.7%
of 11-17 year-olds) compared with parent or carer reported information (4.7% of 11-17 year-olds).
However, the prevalence is considerably higher when considered together (i.e. when either source is
used as the basis for classification), with one in ten young people (10.5% of adolescents aged 11-17
years) meeting the diagnostic criteria for major depressive disorder based on information provided by
either or both the young person and his or her parent or carer.
The prevalence of major depressive disorder was higher in females than in males and the difference
was greater when the prevalence was based on adolescent report (11.0% for females and 4.5% for
males compared with 5.7% for females and 3.7% for males when based on parent and carer report).
The Mental Health of Children and Adolescents 99
Table 10-3: Prevalence of major depressive disorder among 11-17 year-olds by sex, age group and
informant
Sex Age group
Adolescent
report (%)
Parent/carer
report (%)
Adolescent
report and/or
parent/carer
report (%)
Males 11-15 years 3.1 3.1 5.4
16-17 years 8.2 5.4 11.4
11-17 years 4.5 3.7 7.1
Females 11-15 years 7.2 3.6 9.5
16-17 years 19.6 10.6 24.3
11-17 years 11.0 5.7 14.0
Persons 11-15 years 5.0 3.3 7.3
16-17 years 14.0 8.1 18.0
11-17 years 7.7 4.7 10.5
Young people rated how much their parents or carers knew about how they were feeling. Among
adolescents who did not have major depressive disorder based on either their own or their parent’s
and carer’s reports, 7.4% said their parents or carers know ‘not at all’ how they are feeling, compared
with 14.9% of young people where both the adolescent report and parent or carer report indicate the
young person had major depressive disorder, and 29.5% where only the adolescent report indicated
the young person has major depressive disorder. Among adolescents without major depressive
disorder 40.2% said their parents or carers knew a lot about how they were feeling compared with
14.3% of adolescents with major depressive disorder identified based on the adolescent report only.
Two thirds of young people with major depressive disorder based on information in their self-report
said that their parents or carers only knew ‘a little’ or ‘not at all’ about their feelings (37.6% and 29.5%
respectively). Where parents and carers had also provided information on which to base a diagnosis
of major depressive disorder, just over half of young people reported that their parents or carers had
poor knowledge about how they were feeling (40.3% ‘a little’ and 14.9% ‘not at all’). In contrast three
quarters (75.7%) of young people without major depressive disorder reported that their parents or
carers knew ‘a lot’ or ‘some’ about how they were feeling (Table 10-4).
100 The Mental Health of Children and Adolescents
Table 10-4: Young people’s perceptions of how much parents or carers know about how they are
feeling for those with and without major depressive disorder
Level of parental/carer knowledge
Major depressive
disorder based on
adolescent report
only (%)
Major depressive
disorder based on
both adolescent and
parent/carer reports
(%)
No major depressive
disorder (%)
A lot 14.3 18.1 40.2
Some 18.6 26.6 35.5
A little 37.6 40.3 16.8
Not at all 29.5 14.9 7.4
10.4 Psychological distress
The Kessler 10 Psychological Distress Scale (K10) is a measure of psychological distress that has been
shown to be highly correlated with the presence of depressive or anxiety disorders. Scores are
classified into four levels of psychological distress — low, moderate, high and very high distress.
One fifth of adolescents aged 11-17 years had very high or high levels of psychological distress (6.6%
and 13.3% respectively). The proportion was higher for females than males (9.5% and 16.4%
compared with 4.0% and 10.4%). A higher proportion of older adolescents had very high and high
levels of psychological distress (11.0% and 16.2% of 16-17 year-olds compared with 4.8% and 12.2% of
11-15 year-olds) (Table 10-5).
Table 10-5: Kessler 10 level of psychological distress among 11-17 year-olds by sex and age group
Sex Age group Low (%) Moderate (%) High (%) Very high (%)
Males 11-15 years 57.6 29.2 9.9 3.3
16-17 years 53.0 29.4 11.8 5.8
11-17 years 56.3 29.3 10.4 4.0
Females 11-15 years 49.8 28.9 14.7 6.6
16-17 years 34.8 29.0 20.3 15.9
11-17 years 45.1 29.0 16.4 9.5
Persons 11-15 years 53.9 29.1 12.2 4.8
16-17 years 43.6 29.2 16.2 11.0
11-17 years 50.9 29.1 13.3 6.6
Four fifths of young people who were identified as having major depressive disorder from
information that they provided alone also had very high and high levels of psychological distress
(45.2% and 35.5% respectively). The proportion was slightly higher for young people with major
depressive disorder identified from both parent or carer and adolescent reported information, with
just over half (55.2%) being very highly distressed and another 36.0% highly distressed. The level of
distress was not as strongly associated with major depressive disorder status based on parent or
The Mental Health of Children and Adolescents 101
carer report only, with just over one third of young people (36.0%) who were identified as having the
disorder based on information from their parents and carers only reporting that they had low levels
of distress (Table 10-6).
Table 10-6: Kessler 10 level of psychological distress among 11-17 year-olds by major depressive
disorder status
Level of psychological distress
Adolescent
report only (%)
Parent/carer
report only (%)
Both parent/
carer report and
adolescent
report (%)
No major
depressive
disorder (%)
Low 5.4 36.0 np 55.4
Moderate 13.9 28.1 np 30.6
High 35.5 24.1 36.0 11.1
Very high 45.2 11.9 55.2 3.0
np Not available for publication because of small cell size, but included in totals where applicable.
10.5 Strengths and difficulties questionnaire
The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire
comprising five subscales of five items each. Items in four of these subscales, that is emotional
problems, conduct problems, hyperactivity and peer problems, are combined to generate a total
difficulties score. Scores in the ‘abnormal’ range indicate substantial risk of clinically significant
problems. The SDQ was designed so that approximately 10% of children and adolescents will fall into
the ‘abnormal’ range on the total difficulties score.
One tenth (10.2%) of young people aged 11-17 years scored in the abnormal range on the SDQ total
difficulties scale. The proportion was higher in females than males (12.1% compared with 8.3%), and
higher in older adolescents than younger adolescents (12.4% in 16-17 year-olds compared with 9.2%
in 11-15 year-olds) (Table 10-7).
Table 10-7: SDQ total difficulties score among 11-17 year-olds by sex and age group
Sex Age group Normal (%) Borderline (%) Abnormal (%)
Males 11-15 years 77.7 13.6 8.7
16-17 years 80.5 12.2 7.3
11-17 years 78.5 13.2 8.3
Females 11-15 years 76.0 14.2 9.8
16-17 years 69.6 13.1 17.3
11-17 years 74.0 13.9 12.1
Persons 11-15 years 76.9 13.9 9.2
16-17 years 74.9 12.6 12.4
11-17 years 76.3 13.5 10.2
102 The Mental Health of Children and Adolescents
The proportion of young people with abnormal scores was highest on the hyperactivity scale followed
by the emotional problems scale (13.8% and 10.9% respectively). Emotional problems were more
prevalent in females than males (16.3% compared with 5.8%), while conduct problems were more
common in males than females (10.0% compared with 7.5%). Emotional problems were more
common in older adolescents compared with younger adolescents (16.0% in 16-17 year-olds
compared with 8.8% in 11-15 year-olds) (Table 10-8).
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