Adolescent mental health

1. Key messages

2. Self-perception of health

Boys are more likely to report excellent perceived health compared to girls

In 2018, the proportion of adolescents aged 11 to 18 years with excellent self-perceived health was 35% for boys and 24% for girls in Belgium. As they get older, fewer adolescents, especially girls, report themselves to be in excellent health. Between the ages of 11 and 18, the figures drop from 39% to 31% for boys, and from 33% to 16% for girls.

Health perceived as excellent does not vary much between the two communities

The differences in self-perceived health are small between the two communities. The proportion of boys who perceive their health as excellent was slightly higher among the adolescents from the French Community (36% vs 34%) and, among girls, the proportion was slightly higher among the adolescents from the Flemish Community (25% vs 24%).

There is an important gap in health perception between adolescents of low and high levels of family affluence in the Flemish Community

Among 15 year-old adolescents, excellent perceived health status was associated with high family affluence in the Flemish Community. Boys and girls from the most affluent families were respectively 1.7 times and 2 times more likely to report being in excellent health than those in lower affluent families. In the French Community, the difference in affluence was only observed in girls, with girls from the most affluent families being 1.2 times more likely to report an excellent health status than girls from the lowest affluent families. 

Some differences between the Communities were also observed by family affluence group:  among the low affluence families, boys from the French Community were 1.6 times more likely to report being in excellent health than boys from the Flemish Community. Among both the low affluence families and the high affluence families, girls from the French Community were respectively 2.5 and 1.5 times more likely to report excellent perceived health than girls from the Flemish Community. 

Belgium ranks lower than the EU-15 average in health perception in 2018

The 2018 HBSC international report reveals that for the EU-15 countries, 34% of 15-year-old boys and 21% of 15-year-old girls rated their health as excellent. This proportion ranged from 19% to 53% across countries for boys and 12% to 33% for girls. With 33% of 15-year-old Belgian boys and 18% of 15-year-old Belgian girls describing their health as excellent, Belgium is below the EU-15 averages.

3. Self-reported symptoms

Sleep difficulties, feeling nervous, and feeling irritable are the top 3 symptoms reported by boys and girls in Belgium

In 2018, for all adolescents aged 11 to 18 years old, the most frequently symptoms reported daily or more than once a week were sleep difficulties (29% for boys, 36% for girls), feeling nervous (24% for boys, 32% for girls) and feeling irritable (19% for boys, 28% for girls). Conversely, feeling dizzy, headache and stomach pain were the least frequently reported symptoms.

Across all school grade levels, more girls than boys reported having experienced each type of symptom more than once a week. In addition, the order of frequency with which symptoms were reported remained the same for boys and girls.

Symptoms increased with age, particularly in girls 

Among girls, several symptoms were much more common at age 15 than at age 11. Feeling nervous increases from 21% to 34%, feeling irritable from 18% to 32%, feeling low from 15% to 26%, back pain from 10% to 19%, headaches from 12% to 22%, and feeling dizzy from 8% to 14%. Stomach pain remained more or less stable and only sleep difficulties decreased consistently with age.

For boys, reporting back pain was more common at age 15 than at age 11, as did, to a lesser extent, feeling nervous, feeling irritable, and feeling dizzy. Sleep difficulties became significantly less frequent with age, from 33% at age 11 to 24% at age 15. Stomach pain also decreased with age. 

Boys and girls in the French Community had more symptoms than those in the Flemish Community

Boys and girls in the French Community reported symptoms more frequently than those in the Flemish Community. This difference is even more pronounced for girls than for boys, especially for sleep difficulties, feeling nervous, and feeling low.

Family affluence has an impact on some of the reported symptoms

In 2018 at age 15, in the French Community, boys from low affluence families reported more frequently feeling nervous (30% vs. 22%) and feeling irritable (24% vs. 12%) than those from a high affluence background. The frequency of psychosomatic symptoms in boys was not different by family affluence in the Flemish Community.

In both Communities, the proportion of girls feeling irritable was higher in low affluence families (26% on average) than in high affluence families (18% on average). The same was true for feeling low (24% in low affluence families and 14% in high affluence families). Girls from less affluent families were also more likely to report headaches in both Communities (18% vs 13%), although the difference was not statistically significant for those from the French Community.

Belgian numbers are close to the EU-15 average for multiple health complaints in 2018 

The 2018 HBSC international report reveals that for the EU-15 countries, on average 30% of 15-year-old boys and 49% of 15 year-old girls reported multiple health complaints (MHC) more than once a week. This proportion ranges from 19% to 44% for boys and 40% to 75%  for girls. With 30% of 15 year-old Belgian boys and 50% of 15 year-old Belgian girls reporting MHC, Belgium was comparable to the European average for boys and slightly below the EU average for girls.

4. Life satisfaction

Boys were more satisfied with their lives than girls

The proportion of adolescents who felt they were moderately or very satisfied with their lives was 92% for boys and 87% for girls in 2018 in Belgium. This proportion varied little with age for boys, but dropped sharply for girls between ages 11 and 16, then rose slightly at ages 17 and 18.

Adolescent boys and girls were feeling more satisfied with their lives in 2018 than in 2014 in both Communities

In both Communities, the proportion of boys reporting moderate to high satisfaction with their lives increased between 2014 and 2018 (from 88 to 91% for the French Community and from 91 to 95% for the Flemish Community). In the Flemish Community, the proportion of girls with moderate to high life satisfaction increased between 2014 (85%) and 2018 (91%), while in the French Community, it remained stable. 

For both genders, the proportion of adolescents reporting moderate to high satisfaction with their lives was higher in the Flemish Community than in the French Community.

Adolescents living in affluent families had a higher life satisfaction

For 15 year-old adolescents of both genders and both Communities, living in a high affluence family was generally associated with a higher life satisfaction score. The greatest difference was observed among adolescents from the Flemish Community with a mean satisfaction score difference of 0.6 points (among girls and boys). By gender, the score was fairly similar across Communities when family affluence level was taken into account. 

Belgian adolescents reported an above average life satisfaction among EU-15 countries 

The 2018 HBSC International Report reveals that for EU-15 countries, the average life satisfaction score for 15 year-olds was 7.5 for boys and 7.1 for girls. This variable ranges from 6.7 to 7.9 for boys and from 6.7 to 7.4 for girls. With an average life satisfaction score of 7.6 for Belgian 15 year-old boys and 7.2 for Belgian 15 year-old girls, Belgium is above the EU average.

5. Read more

View the metadata for this indicator

HBSC Fédération Wallonie-Bruxelles

HBSC Vlaanderen

Background

According to the WHO (World Health Organization), in 2021, one in seven 10-19 year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group [4]. Depression, anxiety and behavioral disorders are among the leading causes of illness and disability among adolescents. The consequences of failing to address adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.

According to the latest UNICEF estimates, more than 16.3% of young people aged 10 to 19 in Belgium are diagnosed with a mental disorder in line with the World Health Organization's definition [5]. They suppose that these estimates are probably the tip of the iceberg because many children are not diagnosed and the COVID-19 pandemic has raised immense concerns regarding young people’s well-being.

On 30 March 2015, the Interministerial Conference on Public Health (IMC) approved the “Guide to a new mental healthcare policy for children and young people (GMCY)” [6]. Almost immediately, 11 GMCY networks were set up, focusing on children and young people within their area of action. A GMCY network provides a comprehensive and integrated range of services for all children and young people aged 0-23 with mental and/or psychiatric problems. The aim is to respond to the needs of these children, young people and their context or environment as quickly and continuously as possible.

Although networks offering mental health support to young people are developing in Belgium, to date there are relatively few studies that provide national estimates on children’s mental health, especially among the youngest age groups. In 2018, the Belgian Health Interview Survey (HIS) [7] extended for the first time its field of investigation to include child mental health difficulties, thus providing new elements on the subject. The HBSC (Health Behaviour in School-aged Children) surveys currently provide the most information on the emotional well-being of Belgian youth aged 11 to 18 years.

We used the HBSC surveys to describe three aspects of adolescent mental well-being in Belgium: 

• Self-perceived health, measuring the proportion who consider their health to be excellent.
• Self-reported symptoms, with a list of 8 symptoms and their frequency.
• Life satisfaction, assessing how satisfied they are with their life based on the Cantril scale.

Definitions

Self-reported symptoms (psychosomatic symptom)

Symptoms caused by stress and worry, rather than by a physical problem such as an infection. This HBSC indicator includes a list of eight symptoms, for which adolescents were asked to report the frequency with which they have experienced them over the past six months. Five frequency categories, ranging from "about every day" to "rarely or never," were provided.

Multiple Health Complaints (MHC)

In the HBSC international study, adolescents reporting at least two of the eight listed symptoms with a frequency of at least weekly were classified as having MHC.

Self-perceived health

The perceived state of health of teenagers attending school was assessed in the HBSC studies by using the question: "Would you say that your health is...". Four response categories were proposed: "excellent", "good", "rather good" and "not very good". Students who rated their health as "rather good" or "not very good" were considered to have a rather negative perception of their health.

Life satisfaction

In the Belgian HBSC studies, adolescents’ level of satisfaction with their lives is measured using the Cantril scale. It is graduated from 0 to 10, with the value 10 representing "the best possible life" and the value 0, "the worst possible life". Following the international protocol of the HBSC study, adolescents with a level between 6 and 10 were considered to have moderate to high satisfaction with their lives.

Family affluence

To classify different socioeconomic groups, HBSC studies use the Family Affluence Scale (FAS), which asks young people about household material possessions using a six-item questionnaire. Responses are scored and summed to form an HBSC FAS score, which has been shown to be a valid indicator of relative affluence. The affluence score is then used to identify groups of young people in the lowest 20% (low affluence), the middle 60% (medium affluence) and the highest 20% (high affluence).

References

1. HBSC Fédération Wallonie-Bruxelles, ULB, 2018. http://sipes.ulb.ac.be/
2. HBSC Communauté flamande, UGent, 2018. https://www.jongeren-en-gezondheid.ugent.be/ 
3. Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. International report. Volume 2. Key data, WHO Regional Office for Europe, 2020. https://www.who.int/europe/health-topics
4. Mental health of adolescents. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health/
5. Rapport des enfants et des jeunes. https://www.unicef.be/sites/default/files/2022-06/Rapport%20What%20do%20you%20think%202022%20FR%20LR.pdf/
6. Networks in mental healthcare for children and young people. https://www.healthybelgium.be/en/key-data-in-healthcare/mental-healthcare/mental-healthcare-for-children-and-young-people/organisation-of-the-care-offering-for-children-and-young-people/networks-in-mental-healthcare-for-children-and-young-people/
7. https://www.sciensano.be/en/projects/health-interview-survey

Please cite this page as: Sciensano. Mental health: Adolescents mental health, Health Status Report, 11 Aug 2023, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mental-health/adolescents-mental-health