- sociocultural (e.g. age, gender, family structure, Aboriginality, ethnicity, geographic location)
- socioeconomic (e.g. low education, low SES)
Age can be a determinant of health. The burden of disease from mental illnesses for both sexes was greater in early to mid adulthood than at other ages (Australia’s health, 2010 , AIHW). The ABS 2007 National Survey of Mental Health and Wellbeing found more than one in four young people aged 16–24 years have a mental disorder, including substance use disorders compared to approximately one in five in the general population (State of Australia’s Health, 2009). Young men are more likely to suicide between the ages of 20-24 years than they are between 15 and 19 years. Comparatively, young females are more likely to suicide as teenagers than young adults (State of Australia’s Health, 2009).
In relation to mental health problems and illnesses, gender plays a substantial role. Young women have been found to be more likely to report high or very high levels of psychological distress than young men (Australia’s health, 2010 , AIHW). Young men were most likely to have a substance use disorder compared to young women who were more likely to experience an anxiety disorder (State of Australia’s Young People, 2009). The most common reasons for mental and behavioural disorder hospitalisations among young males were substance use and schizophrenia, whereas depressive episodes and eating disorders were the most common among young females (Australia’s health, 2010 , AIHW). The hospitalisation rate for intentional self-harm among females was more than twice that for males in 2005-06 (AIHW National Hospital Morbidity Database, cited in State of Australia’s Young People, 2009). Young women have been found to use less lethal and violent methods to attempt suicide than males thereby resulting in higher rates of self harm and hospitalisation. Men on the other hand, are considerably more likely to use violent measures resulting in higher rates of suicide and higher mortality rates. Females have also been found to access more services and seek help. This can be linked by societal ideas about males dealing with challenges themselves. This is a social norm we must work to break down to encourage all young people to access services and help when needed.
Strong friendships and family relationships are critical for young people’s social and emotional development. Young people most at risk from social isolation are those without family support who do not study or work, those who do not have friends and young people with a disability (State of Australia’s Young People, 2009) Family structure and the family environment will play a major role in determining a young person’s mental health outcomes. As discussed in the protective factors section, young people with strong bonds and connections with family and friends will experience better mental health outcomes.
Smart and Vassallo (2008), for example, found that, where parent–child relationship quality was high (as reported by both parents and adolescents) teenagers were progressing well in school, were more adaptable, socially adept and displayed fewer problems such as antisocial behaviour or depression than young people with poor quality parental relationships (State of Australia’s Young People, 2009).
Many Aboriginal and Torres Strait Islander people experience multiple risk factors for mental health problems and illnesses. They often live in situations of socioeconomic disadvantage, including homelessness, poverty or unemployment. Indigenous young people have poorer educational attainment and achievement compared to their non- Indigenous counterparts. They are less likely to have completed Year 12, they have lower participation rates in education at secondary and tertiary levels, and they have poorer attendance rates and performance (State of Australia’s Young People, 2009). Education empowers young people to make informed decisions in relation to their health and lifestyle. Low levels of education can be linked to risk behaviours and may result in substance abuse or conduct disorders. It also reduces one’s awareness of and access to health care services impacting on health literacy and help seeking skills.
Employment rates vary for different groups of young people. However, Indigenous young people are less likely than all Australian young people to be employed, and the gap widens as teenagers become young adults (State of Australia’s Young People, 2009). Unemployment has a direct impact on how a young person views their future. Unemployment can reduce a person’s self esteem and self confidence reducing mental health status. Indigenous young people are more likely to be the victims of violent crime than other young people State of Australia’s Young People, 2009). Being a victim of crime can negatively impact on health, well-being, and perceptions of safety. Indigenous young people are also at risk of racism and discrimination will degrades their identity and makes young Indigenous people feel socially isolated.
Many cultures have strong obligations to family. Therefore young people born overseas may be expected to take on more responsibility than is usual in Australia, such as caring for younger children or financially contributing to the household. This can place young people under greater stress and cause conflict within the family. Differences in gender roles between cultures are also a common issue, particularly in relation to the status and expectations of young women. Young people may feel the need to challenge these expectations as they seek independence, resulting in rebellious behaviour or conflict with family members. Culture can also place a young person at risk of discrimination which directly impact on how they view themselves and the level of security and safety they feel in their environment. Language barriers and cultural differences may leave young people feeling isolated. Language barriers and cultural barriers may also directly impact on educational and employment opportunities. These challenges can be associated with increased risk behaviours, vulnerability, anxiety and low self esteem.
Geographic location can impact on a person’s access to services, education, employment and transport. Young people living in rural areas may feel isolated and lack confidence in their ability to access services outside of their town. Francis et al., (2006, cited in State of Australia’s Young People, 2009) found a range of barriers to help-seeking for young people in rural areas. These included a lack of specialist local services, a need to travel to gain appropriate access, fear of social stigma, a lack of anonymity in rural towns and the perception that seeking help is a sign of weakness. An inability to access appropriate services can inhibit a young person’s ability to feel connected and be supported. Mental health problems and illnesses may go undiagnosed and untreated resulting in long term consequences and health effects. It may also result in risk taking behaviour such as binge drinking and use of drugs or unsafe sexual practices.
Young people’s future outcomes are strongly related to their education. Education is one of the most important dimensions of young people’s lives because it can decide future opportunities and outcomes (Becker, 1975; cited in State of Australia’s Young people, 2009). Education also provides opportunities for young people to develop essential skills to maintain good mental health such as resilience, conflict resolution, assertiveness and problem solving. Involvement in education empowers young people to make informed decisions in relation to their health.
The school environment can be positive and encourage opportunities for leadership and decision making strengthening a young person’s feelings of belonging and self worth. The school environment for some young people can be destructive and can be a place where bullying, low achievement and social isolation reduce their confidence and causes anxiety and distress.
Education and employment are areas young people focus much of their time and effort on. Young people’s income is closely tied to their participation in employment and education. Almost half of teenagers and two in three young adults are employed, although unemployment has increased considerably for young people as a result of the recent global economic crisis and young people both in and out of work are concerned about their future employment prospects (State of Australia’s Young People, 2009). It has been found that 13 per cent of young people out of work and education report high levels of psychological distress, compared to 5–7 per cent of young people in paid work and/or education.
Homeless young people often face multiple disadvantages such as poverty, poor access to health care, low educational participation and poor employment prospects (State of Australia’s Young People, 2009). Homelessness is also linked to family conflict, violence and abuse, social isolation, substance abuse and mental health problems (DEECD, 2008; Chamberlain et al., 2007; Grace et al., 2008; Johnston and Chamberlain, 2008; cited in State of Australia’s Young People, 2009).
Sexual orientation and issues of sexuality will cause challenges for young people as they move through adolescence and into adulthood. Approximately 1 in 10 young people do not identify as exclusively heterosexual, therefore identify attraction to the same sex or both sexes.
Same sex attracted young people often feel confused about their feelings and some experience feelings of guilt and shame as they hide their sexuality and sexual identity. This affects how a young person views themselves and their value or self worth. Young people unable to identify openly and express who they are may withdraw and isolated themselves leading to low self esteem and self confidence.
Same sex attracted young people often find it difficult to tell people close to them about how they are feeling. Many young people are concerned about losing the respect and love of their friends and family. They also fear rejection and the consequences of that rejection. Same sex attracted young people often feel isolated, particularly same sex attracted young people living in rural and remote communities. Friends remained the most popular confidantes for young people to disclose their sexuality to, followed by mothers (Writing themselves in again, 2004). There is reason to believe that young people who are isolated and unsafe in their day-to-day world can connect to a world that is more supportive and accepting through the internet.
Many young people (38%) have identified experiencing unfair treatment on the basis of their sexuality despite the fact that such treatment is illegal throughout Australia (Writing themselves in again, 2004). In addition, 44% reported verbal abuse and 16% reported physical assault because of their sexuality, figures that are largely unchanged from 1998 (Writing themselves in again, 2004). Verbal abuse extended beyond name-calling and insults to include threats and rumour mongering. Physical abuse ranged from having clothes and possessions damaged to rape and hospitalisation for injuries.
The most common site for this abuse, as in 1998, was school and this remains the most dangerous place for these young people to be with 74% of all the abuse happening there (Writing themselves in again, 2004). Those who had been abused were more likely to self-harm, to report an STI and to use a range of legal and illegal drugs (Writing themselves in again, 2004).
Same Sex Attracted (SSA) young people were more likely to be sexually active earlier than their heterosexual peers (Writing themselves in again, 2004) resulting in further difficulties and responsibilities in relation to their sexual behaviour, contraception and safety.
In 2004 both young men and young women were more likely to identify as gay, homosexual or lesbian than in 1998, possibly reflecting the social changes that have made this more acceptable (Writing themselves in again, 2004). There was a shift towards more positive feelings about their sexuality with 76% of young people surveyed feeling great or good in 2004 compared with 60% in 1998. Again this is possibly the result of more widespread acceptance of diverse sexuality. Greater acceptance is required to reduce the significant impact the determinant of sexual orientation has on a young person’s mental health.
The young people most at risk of mental health problems and illnesses are: