Prevalence and Associated Factors of Emotional and Behavioural Difficulties in Latvian Adolescent Population. Summary of the Doctoral Thesis

Abstract

Introduction. Adolescence is a critical period for the development of mental disorders, which have emerged in recent decades as the most serious public health problem among young people. Research shows a complex relationship between a wide range of health-related and health-influencing factors and an increased risk of emotional and behavioural disorders in adolescence. To successfully develop and implement prevention and treatment strategies, we need reliable and validated screening methods for emotional and behavioural difficulties in the adolescent population, as well as in-depth knowledge of population-specific risk and protective factors. The aim of this study was to investigate the prevalence of emotional and behavioural difficulties in the Latvian adolescent population and associated socio-demographic, healthrelated and health-promoting factors, as well as to assess the suitability of a screening instrument for the detection of emotional and behavioural difficulties in adolescents, both in the general population and in clinical practice. Materials and methods. Data were analysed from two separate but conceptually and methodologically related datasets: a representative Latvian general population sample of 11-, 13- and 15-year-olds (n = 4385) and a clinical help-seeking population sample of 11- to 17-year-olds (n = 207). The Strengths and Difficulties Questionnaire (SDQ) was used to screen for emotional and behavioural difficulties in both samples. The appropriateness of the screening tool was assessed by analysing its psychometric properties in both study samples, while the association of emotional and behavioural difficulties with individual and environmental psychosocial health determinants was examined in the general population sample using statistical modelling techniques by identifying unadjusted and adjusted odds ratios for sociodemographic factors, and by testing for interactions with gender and age. Results. The adolescent self-report SDQ showed inconsistent internal consistency scores in both Latvian and Russian samples of the study population. The SDQ scales for emotional difficulties, prosocial behaviour, internalising difficulties, and total difficulties reached a reasonable level of reliability (Cronbach's alpha above 0.7). The hyperactivity, peer relations and externalising difficulties scales had low internal consistency (Cronbach's alpha between 0.5 and 0.6), while the conduct difficulties subscale had very low internal consistency (Cronbach's alpha below 0.5). Adolescents in the clinical population sample scored significantly higher on the emotional difficulties, peer problems and hyperactivity subscales of the SDQ than adolescents 6in the general population sample, but there were no significant differences between groups on the conduct problems and prosocial behaviour subscales. In the clinical population sample, the presence of a diagnosis of an internalising disorder was significantly correlated with positive screening results on the emotional difficulties, internalising difficulties and general difficulties scales of the SDQ. A diagnosis of externalising disorder was significantly correlated with positive screening results on the hyperactivity subscale and negative screening results on the emotional difficulties and internalising difficulties scales. The sensitivity and specificity of the internalising difficulties scale for clinical diagnoses of internalising disorders were 56 % and 73 %, respectively. The sensitivity and specificity of the Externalising Difficulties scale for clinical diagnoses of externalising disorders were 38 % and 75 %, respectively. Overall, none of the adolescent self-report scales of the SDQ showed sufficient clinical utility to be useful in everyday clinical decision making. In the general population sample, significant emotional difficulties were found in 9.3 %of young people and behavioural difficulties in 6.4 %. Emotional difficulties were generally less common in boys than in girls and decreased slightly with age. For girls, however, emotional difficulties increased significantly with age. Behavioural difficulties were significantly more common among 11-year-old boys than among girls, but the prevalence of behavioural difficulties equalised between the sexes with increasing age. In the case of emotional difficulties, problematic social media use showed the strongest association for boys, while multiple health complaints, low self-esteem and experience of teasing in both school and e- environments showed the strongest association for girls. For both sexes, emotional difficulties were strongly associated with low health self-esteem and low health-related quality of life. For girls, behavioural difficulties were most strongly associated with low health-related quality of life, smoking, alcohol consumption and low subjective importance of relationships with others. For both sexes, behavioural difficulties were strongly associated with problematic social media use and bullying others, both at school and in the e-environment. Conclusions. The self-report version of the SDQ in the Latvian adolescent population as a whole shows sufficient internal validity to be used to draw conclusions about the prevalence of emotional and behavioural difficulties and their influencing factors in the general Latvian adolescent population. Internalising and externalising difficulties identified by the SDQ have statistically significant correlations with clinically diagnosed mental disorders, but the sensitivity and specificity of this screening questionnaire, as well as other predictive values, are not sufficient to make it useful for routine clinical practice. The prevalence of internalising and externalising difficulties in the Latvian population of 11-, 13- and 15-year-old adolescents is high, with strong gender and age effects. The 7 dissertation study identified both universal and gender-specific socio-demographic, health and health-related factors that are reliably associated with significantly increased odds of internalising and externalising difficulties. It is important to take these data into account when designing and implementing primary and secondary prevention programmes, as well as when planning public policies on young people's mental health.