Trends in mental health problems among young people and the presence of youth clinics in Sweden: An ecological controlled interrupted time series analysis using the Health on Equal Terms surveys (2004 to 2021)
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Abstract
Introduction: In Sweden, youth clinics (YCs) address, among other things, issues related to the mental well-being among young people. However, YCs´ impact on their mental health have not been assessed. This study aimed to: i) analyse trends in mental health outcomes (stress, anxiety and psychological distress) among young people in Sweden according to the municipal availability of YCs; and ii) assess the impact on mental health outcomes of the presence of YCs with a first-line mental health (FLMH) assignment and YCs without this assignment, as compared to municipalities without YCs.
Methods: An ecological controlled interrupted time series design was applied. Annual data over 18 years (2004-2021) on self-reported stress, anxiety and psychological distress of individuals aged 16-25 were used. Thus, the mental health outcome trends in municipalities with YCs and those without YCs were compared. The prevalence ratio and their 95% confidence intervals were estimated.
Results: In total, 17,174 young people aged 16–25 participated in the study. A decrease in the reporting of stress, anxiety and psychological distress was observed from 2004 to 2010, followed by an increase in all three outcomes during the period 2011–2021. Trends were not statistically significant different in municipalities with or without YCs (even among YCs with the FLMH assignment).
Conclusion: The prevalence of mental ill-health has been increasing among young people in Sweden since 2011. While YCs play an important role in the prevention of mental illness, their impact on these trends could not be determined. We recommend that structural factors such as education and the labour market for youth, which are outside the scope of YCs, should be addressed to curb these trends.
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References
Mei C, Fitzsimons J, Allen N, Alvarez-Jimenez M, Amminger GP, Browne V, Cannon M, Davis M, Dooley B, Hickie IB, Iyer S, Killackey E, Malla A, Manion I, Mathias S, Pennell K, Purcell R, Rickwood D, Singh SP, Wood SJ, Yung A, McGorry PD. Global research priorities for youth mental health. Early Interv Psychia. 2020;14(1):3-13.
Patel V, Saxena S, Lund C, Kohrt B, Kieling C, Sunkel C, Kola L, Chang O, Charlson F, O'Neill K, Herrman H. Transforming mental health systems globally: principles and policy recommendations. Lancet. 2023;402(10402):656-666.
Bremberg S. Mental health problems are rising more in Swedish adolescents than in other Nordic countries and the Netherlands. Acta Paediatr 2015;104:997–1004.
Calling S, Midlöv P, Johansson S-E, et al. Longitudinal trends in self-reported anxiety. Effects of age and birth co-hort during 25 years. BMC Psychiatry 2017;17:119.
Swedish Association of Local Authorities and Regions (Sveriges Kommuner och Regioner). Psykisk hälsa på ung-domsmottagningen – en kartläggning av Sveriges ungdomsmottagningar. Stockholm: SALAR, 2017.
Swedish Association of Local Authorities and Regions (Sveriges Kommuner och Regioner). Första linjen 2020 Nu-lägesbeskrivning av hälso- och sjukvårdens första linje för barn och ungas psykiska hälsa. Stockholm: SALAR, 2020
National Board of Health and Welfare (Socialstyrelsen) . Kartläggning av första linjens verksamhet för barn och unga Med psykisk ohälsa. Stockholm: Socialstyrelsen, 2021.
Thomée S, Malm D, Christianson M, Hurtig A-K, Wiklund M, Waenerlund A-K, et al. Challenges and strategies for sustaining youth-friendly health services—a qualitative study from the perspective of professionals at youth clinics in northern Sweden. Reprod health. 2016;13(1):147.
Waenerlund A-K, San Sebastian M, Hurtig A-K, Wiklund M, Christianson M, Goicolea I. Assessing the youth-friendliness of youth clinics in northern Sweden: a survey analyzing the perspective of the youth. BMC Health Serv Res. 2020;20(1):1-8.
Baroudi M, San Sebastian M, Hurtig A-K, Goicolea I. The perception of youth health centres’ friendliness: does it differ between immigrant and Swedish-Scandinavian youths? Eur J Public Health. 2020;30(4):780-5.
Mosquera PA, Waenerlund A-K, Goicolea I, Gustafsson PE. Equitable health services for the young? A decomposition of income-related inequalities in young adults’ utilization of health care in Northern Sweden. Int J Equity Health. 2017;16(1):20.
McGorry P, Bates T, Birchwood M. Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. B J Psych. 2013;202(s54):s30-s5.
Rickwood D, Paraskakis M, Quin D, Hobbs N, Ryall V, Trethowan J, et al. Australia's innovation in youth mental health care: the headspace centre model. Early Interv Psychia. 2019;13(1):159-66.
Goicolea I, Hultstrand Ahlin C, Waenerlund A-K, Marchal B, Christianson M, Wiklund M, et al. Accessibility and factors associated with utilization of mental health services in youth health centers. A qualitative comparative analysis in northern Sweden. Int J Ment Health Syst. 2018;12(1):1-9.
Uppdrag Psykisk Hälsa. Psykisk hälsa på ungdomsmottagningen - en kartläggning av Sveriges ungdomsmottagningar. Stockholm: SKL; 2017.
FSUM. Riktlinjer för Sveriges ungdomsmottagningar. Stockholm: FSUM; 2018.
SKR. Första linjen för barns och ungas psykiska hälsa 21/22. Stockholm: SKR; 2022.
Socialstyrelsen. Kartläggning av första linjens verksamhet för barn och unga med psykisk ohälsa. Stockholm: Socialstyrelsen; 2021.
Folkhälsomyndigheten. Skolbarns hälsovanor i Sverige 2017/18. Grundrapport. Stockholm: Folkhälsomyndigheten, 2018.
Folkhälsomyndigheten (2022) Statistik psykisk hälsa: yngre vuxna 16–29 år. https://www.folkhalsomyndigheten.se/livsvillkor-levnadsvanor/psykisk-halsa-och-suicidprevention/statistik-psykisk-halsa/statistik-om-ungas-psykiska-halsa/ (Downloaded 230817)
Socialstyrelsen. Stöd till riktade insatser inom området psykisk hälsa Uppföljning och analys av överenskommelser mellan staten och Sveriges Kommuner och Landsting 2016–2018. Stockholm: Socialstyrelsen; 2018.
Goicolea I, Christianson M, Hurtig A-K, Marchal B, San Sebastian M, Wiklund M. Searching for best practices of youth friendly services-a study protocol using qualitative comparative analysis in Sweden. BMC Health Serv Res. 2016;16(1):321.
World Health Organization. Making health services adolescent friendly: developing national quality standards for adolescent friendly health services. Geneva: WHO; 2012.
Goicolea I, Wiklund M, Linander I, Sundberg LR. Protecting, managing and bending boundaries: a biomedicalization perspective on Swedish youth clinics’ responses to mental (ill) health. BMC Health Serv Res. 2022;22(1):1-11.
Settipani CA, Hawke LD, Cleverley K, Chaim G, Cheung A, Mehra K, et al. Key attributes of integrated community-based youth service hubs for mental health: a scoping review. Int J Ment Health Syst. 2019;13(1):1-26.
Hawke LD, Mehra K, Settipani C, Relihan J, Darnay K, Chaim G, et al. What makes mental health and substance use services youth friendly? A scoping review of literature. BMC Health Serv Res. 2019;19(1):1-16.
Cook TD, Campbell DT, Shadish W. Experimental and quasi-experimental designs for generalized causal inference: Houghton Mifflin Boston, MA; 2002.
Penfold RB, Zhang F. Use of interrupted time series analysis in evaluating health care quality improvements. Acad Pediatr. 2013;13(6):S38-S44.
Wagner AK, Soumerai SB, Zhang F, Ross‐Degnan D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299-309.
Lundin A, Hallgren M, Theobald H, Hellgren C, Torgén M. Validity of the 12-item version of the General Health Questionnaire in detecting depression in the general population. Public Health. 2016;136:66-74
Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med. 1997 Jan;27(1):191-7.
Linden A. Conducting interrupted time-series analysis for single- and multiple-group comparison. The Stata J. 2015;15(2):480-500.
van Geelen SM, Hagquist C. Are the time trends in adolescent psychosomatic problems related to functional impairment in daily life? A 23-year study among 20,000 15–16 year olds in Sweden. J Psychosom Res. 2016;87:50-6.
Bremberg S. Mental health problems are rising more in Swedish adolescents than in other Nordic countries and the Netherlands. Acta Paediatr. 2015;104(10):997-1004.
Löfstedt P, Wiklander L, Corell M. Varför har den psykiska ohälsan ökat bland barn och unga i Sverige under perioden 1985–2014? Socialmedicinsk tidskrift. 2020;97(5 och 6):793-803.
Högberg B, Strandh M, Hagquist C. Gender and secular trends in adolescent mental health over 24 years–the role of school-related stress. Soc Sci Med. 2020;250:112890.
Kontopantelis E, Doran T, Springate DA, Buchan I, Reeves D. Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis. BMJ. 2015;350.