Quality of life and mental health among children and adolescents
- Nine out of ten children and adolescents say they are satisfied or very satisfied with their lives and that they enjoy school.
- Eight out of ten adolescents say that they are satisfied with their parents and that they consider them to be an important source of support in their lives.
- Boys are at greatest risk of developmental disorders that begin early in life, such as ADHD, autism spectrum disorders and Tourette’s syndrome, as well as behavioural disorders.
- The prevalence of ADHD is estimated to be 3.4 per cent among twelve year olds, but there is considerable geographic variation in use of the diagnosis. Among teenagers, around four per cent of boys and two per cent of girls are receiving treatment with central stimulant medication for ADHD.
- From puberty onwards, there is a higher frequency of depression, anxiety disorders, adjustment disorders and eating disorders among girls compared to boys.
- An increasing proportion of teenage girls are also reporting symptoms of anxiety and depression in surveys.
The background data for the chapter on quality of life consist of questions which are asked in the nationwide youth surveys (Ungdata) (NOVA, 2017) and the health behaviour surveys among school pupils (HEVAS) (Hemil Centre, 2016). Through Ungdata, we also have data on symptoms of anxiety and depression (NOVA, 2017).
Prevalence figures for mental disorders originate from two Norwegian population-based studies that have mapped diagnoses in children using clinical interviews, "Barn i Bergen" (Heier Vang, 2007) and "Tidlig trygg i Trondheim" (Wichstrøm, 2012).
The clinical interviews were conducted by clinicians with the necessary competence to make diagnoses, i.e. psychologists or child psychiatrists. The Bergen study included seven- to nine-year-olds and was carried out during the period 2002 to 2003. The Trondheim study included children who were four years old at the start of the study and was conducted during the period 2007 to 2009.
We have also referred to other similar population studies conducted among children and adolescents over the past 20 years in the United States (Merikangas, 2010a; Kessler, 2012; Costello, 2003; Angold, 2002; Merikangas, 2010b; Roberts, 2007), the United Kingdom (Ford, 2003) and the Netherlands (Kroes, 2001).
No Norwegian population studies have looked at the prevalence of mental disorders among adolescents using clinical interviews.
We have used data from the Norwegian Patient Registry (NPR) to estimate the proportion of children and adolescents diagnosed with mental disorders by specialist health services, i.e. hospitals, polyclinics, and contracting specialists.
Data from the Norwegian Prescription Database have been used to determine the number of people who have received treatment with antidepressants and ADHD medications, which are the most commonly used drugs in the treatment of mental disorders among children and adolescents.
The descriptions of the mental disorders are based on the ICD-10 disease classifications (WHO, 1990) and DSM-5 (APA, 2013), the textbook Rutter's Child and Adolescent Psychiatry (Thapar, 2015) and an overview article on the continuity of mental problems from childhood to adulthood (Rutter, 2006).
Quality of life
Quality of life is what gives life meaning and value. In particular, subjective aspects such as feeling good and being healthy have attracted attention in health research.
In combination with information regarding life situation and mental disorders, information about quality of life can provide a complete picture of how children and adolescents are actually feeling. An understanding of how mental health and quality co-vary can also help to improve disease prevention and public health strategies.
We do not currently have any holistic information concerning quality of life among children and adolescents in Norway, but both Ungdata and HEVAS contain questions about how satisfied they are with life in general, with their parents, friends and school, and with their health and local environment. The results suggest that most children and adolescents in Norway have a good quality of life (NOVA, 2017; Hemil Centre, 2016):
- Over 90 per cent say they are satisfied or very satisfied with life.
- Eight out of ten adolescents say that they are satisfied with their parents and that they consider them to be an important source of support in their lives. Ten per cent state they are dissatisfied or very dissatisfied with their parents.
- Over 90 per cent of both boys and girls aged 13-18 years say that they enjoy school, and nine out of ten believe that their teacher cares about them.
- Boys are generally more satisfied with life than girls of the same age. For both sexes, satisfaction level decreases from 11 to 16 years of age.
- Adolescents in families who are struggling financially are consistently less satisfied with life in general and with their parents, friends and local environment.
- Well-being at school and life satisfaction are higher among those with well-off families.
The quality of life of children and adolescents is relatively stable in Norway. Results from HEVAS show that, from 2010 to 2014, there was a slight increase in the proportion stating that they are very satisfied with life overall (unpublished data).
The quality of life of children and adolescents is relatively stable in Norway. Results from HEVAS show that, from 2010 to 2014, there was a slight increase in the proportion stating that they are very satisfied with life overall (unpublished data).
Figures from Ungdata for the period 2015 to 2017 suggest that more children and adolescents than previously believe they have a close relationship with their parents, and that more are satisfied with their parents than in previous surveys (NOVA, 2017). More report that their parents know where they are and who they are with (NOVA, 2017). This may be linked to the fact that young people today have a stronger view of their home as a recreational arena than adolescents had in the past.
We know little about the quality of life of children and adolescents who are living with various diseases, mental disorders and disabilities.
Self-reported mental disorders
Ungdata surveys symptoms of anxiety and depression using six questions, where participants are asked whether they have been (NOVA, 2017):
(1) "excessively worried about daily matters "
(2) "feeling everything is an effort"
(3) "having sleep problems"
(4) "feeling unhappy, sad or depressed"
(5) "feeling a sense of hopelessness about the future"
(6) "feeling tense and anxious"
These questions were taken from the Hopkins Symptom Checklist, which is a survey tool for anxiety and depression (Derogatis, 1974). The response categories are: "Not at all", "A little", "Quite a bit" and "Extremely". Those who on average tick "Quite a bit” or more (when their symptoms are summed on a scale) are considered to have a high level of psychological distress (NOVA, 2017).
Among boys, the proportion with a high level of psychological distress remained stable at around six per cent during the period 2011 to 2016 (NOVA, 2017). Among girls, the corresponding proportion rose from 15.9 per cent in 2011 to 19.7 per cent in 2016 (NOVA, 2017).
The rise in reported symptoms among teenage girls may be an indication of an increase in the prevalence of mental disorders in this group. However, the increase is driven by the fact that more people are reporting “worry”, “feeling everything is an effort”, “sleep problems," and "hopelessness" (NOVA, 2016).
When asked whether they have "felt unhappy, sad or depressed", the responses have remained unchanged over time (NOVA, 2016). The findings reflect only an increase in worry, stress and sleep problems but not of feelings of being depressed or sad.
Symptoms of mental disorders
Children grow and develop rapidly and mental disorders and problems appear with different symptoms at different ages. Among young children, symptoms become apparent primarily through changes in behaviour.
- Young children with mental disorders often experience symptoms such as sleep problems, lack of appetite, and psychomotor agitation; and they are often irritable, cry and shout more frequently than normal (Thapar, 2015). Alternatively, they can become passive, withdrawn and not show any pleasure in what would normally be considered to be pleasurable experiences (Thapar, 2015).
- Children with conditions that result in incomplete or delayed cognitive and motor skill development also experience symptoms during their early childhood (Thapar, 2015). This applies to intellectual disability, development disorders such as autism spectrum disorders, ADHD, language disorders, motor delays and learning difficulties.
- By school age, children can express themselves more fully in their own words but they still have limited skills with which to describe their difficulties. At this age, the main symptoms often involve changes in behaviour. They can either withdraw, be sad, not eat much and not show pleasure (internalising symptoms), or they can be hyperactive, impulsive and break norms through their behaviour (externalising symptoms) (Thapar, 2015).
- From puberty onwards, a higher proportion of girls than boys suffer from mental disorders, with the majority covering depression, anxiety disorders, adjustment disorders, and eating disorders. At this age, normally developed adolescents can describe their own symptoms (Thapar, 2015).
Children often face complex difficulties and their symptoms can therefore satisfy the criteria of a number of diagnoses (THAPAR, 2015). For example, children with depression also often suffer from problems with anxiety, and vice versa. Children with ADHD and behavioural disorders also suffer from depression and anxiety more often than other children. Children with developmental disorder can have multiple disorders at the same time, and these can interact with neurological disorders.
Prevalence of mental disorders among children and adolescents
Population-based studies show that mental disorders are common among children and adolescents:
- In the studies from Bergen and Trondheim, around seven per cent of the children had symptoms consistent with a mental disorder at the time of examination (Heier Vang, 2007; Wichstrøm, 2012).
- Similar studies from the United States, the United Kingdom and the Netherlands have found proportions ranging from 7 per cent to 23 per cent (Kessler, 2012; Costello, 2003; Angold, 2002; Merikangas, 2010b; Roberts, 2007; Ford, 2003; Kroes, 2001). The proportions are generally higher among teenagers than among younger children.
- Two of these studies also estimated the proportion of people who have suffered from a mental disorder throughout their life (lifetime prevalence). They found that the proportion was 45 per cent among children aged six to eight years and 50 per cent among teenagers (Merikangas, 2010a; Kroes, 2001).
In Norway, around five per cent of children and adolescents aged 0-17 years are treated every year by the mental healthcare service for children and adolescents (the Children’s and Young People's Psychiatric Out-Patient Clinic). The proportion of children and adolescents given a diagnosis, by age group and gender, is provided in Figures 1a and 1b (as number per 1,000).
- Among girls aged 15 – 17 years, the proportion diagnosed at the Children’s and Young People's Psychiatric Out-Patient Clinic rose during the five-year period from 2011 to 2016, from 5 per cent to 7 per cent per year. The most frequently occurring diagnoses in this group are depression, anxiety disorders, adjustment disorders, and eating disorders.
- In the age groups 5-9 years and 10-14 years, the diagnoses prevalence is higher among boys than girls. This is because they are at greatest risk of developmental disorders that begin early in life, such as ADHD, autism spectrum disorders and Tourette’s syndrome, as well as behavioural disorders.
- The proportion of children with a diagnosis is very low in the age group 0 – 4 years (not shown in figure 1a, b), reflecting the fact that common diagnostic codes are rarely used among this age group.
Figure 1a,b. Click to enlarge. Proportion of children per 1,000 diagnosed with mental disorders and behavioural disorders by the mental health service for children and adolescents (the Children’s and Young People's Psychiatric Out-Patient Clinic) during the period 2008 to 2016, by gender and age category. Background data: Norwegian Patient Registry.
We do not know which factors are contributing to the rise in diagnosed mental disorders among teenage girls. We do not believe that changing referral and diagnostic practices is the explanation. If so, we would have expected to see an increase in other groups as well. The increase correlates with the increase in self-reported mental problems among girls in Ungdata (NOVA, 2017). However, as mentioned previously, it is unclear whether this means that more teenage girls are actually now depressed (NOVA, 2016). It may also seem paradoxical that mental disorders become more common when the vast majority of respondents report good quality of life and well-being. A better understanding is needed of the prevalence of mental disorders among adolescents, ideally through a population survey based on clinical examinations.
In the following, we discuss the most common mental disorders among children and adolescents: depression, anxiety disorders, adjustment disorders, eating disorders, intellectual disability, hyperkinetic disorder (ADHD), autism spectrum disorders, other developmental disorders, behavioural disorders and tic disorders. We also briefly discuss suicide and self-harm.
Depression can occur at any age, but because young children are not normally able to express depressive conditions verbally, the condition can be difficult to diagnose among young children.
- In previous studies, the prevalence has ranged from 0.1 to 1.6 per cent among pre-teen children and from 2.2 to 3.2 per cent among teenagers (Heier Vang, 2007; Wichstrøm, 2012; Kessler, 2012; Costello, 2003; Angold, 2002; Merikangas, 2010b; Roberts, 2007; Ford, 2003; Kroes, 2001).
- One of these studies showed that 14.3 per cent of teenagers had suffered from depression during their lifetime (Merikangas, 2010a).
- Before puberty, the prevalence of depression is similar in girls and boys. After puberty, the prevalence of depression among both sexes increases, but more so in girls than in boys: depression occurs twice as often in girls as boys during the teenage years (Thapar, 2015).
Figure 2 shows the proportion of children and adolescents in Norway diagnosed with depression by the specialist healthcare services during the period 2008 to 2016 by age and gender.
- Among girls aged 15 – 17 years, the proportion diagnosed with depression rose from 1.5 per cent in 2010 to 2.5 per cent in 2013.
- Among boys aged 15 – 17 years, the proportions remained stable at around 0.6 – 0.7 per cent during the same time period.
- Among children under the age of 15 years, relatively few had been diagnosed with depression. This is a low figure in the context of findings from population studies, indicating that many cases of depression in children are not being diagnosed or treated by the specialist healthcare services.
Figure 2. Click to enlarge Proportion of children per 1,000 diagnosed with depression (ICD-10 code F32/F33/F 92.0) during the period 2008 to 2016, by gender and age category. Background data: Norwegian Patient Registry.
Figure 3 above shows the proportions of boys and girls who were treated with antidepressants during the period 2008 to 2016.
- There was an increase in the use of antidepressants among girls aged 15 – 17 years from 2010 to 2016, from 1.2 per cent to 2 per cent.
- We do not see a corresponding increase among boys of the same age. The proportions for boys ranged between 0.6 and 0.8 per cent.
- Antidepressants are rarely used to treat children under the age of ten.
Anxiety disorders are common at all ages, but are most widespread among teenagers.
- In previous studies, the prevalence has ranged from 1.5 to 3.2 per cent among pre-teen children and from 2.4 to 6.9 per cent among teenagers (Heier Vang, 2007; Wichstrøm, 2012; Kessler, 2012; Costello, 2003; Angold, 2002; Merikangas, 2010b; Roberts, 2007; Ford, 2003; Kroes, 2001).
- The types of anxiety disorders that are most prevalent vary to some extent with age, but the most common are specific phobia, separation anxiety and social phobia (Thapar, 2015).
- Studies have shown that 23.9 per cent of 6- to 8-year olds and 31.9 per cent of teenagers have suffered from an anxiety disorder during their lifetime (Merikangas, 2010b; Kroes, 2001).
Figures 4a and 4b show the proportions of children and adolescents in Norway who have been diagnosed with anxiety disorders by the specialist health service:
- Among girls aged 15 – 17 years, the proportion rose from 1 per cent in 2010 to 2.3 per cent in 2016.
- There was also a slight increase among boys aged 15 – 17 years, from 0.5 per cent in 2008 to 0.8 per cent in 2016.
- The proportions appear low for all ages under the age of 14, and many anxiety disorders probably remain undiagnosed by the specialist healthcare services.
Figure 4a, b. Click to enlarge. Proportion of children per 1,000 diagnosed with anxiety disorder (ICD-10 code F40/F41/F92.8/F93.0-F93.2) during the period 2008 to 2016, by gender and age category. Background data: Norwegian Patient Registry.
Of the adjustment disorders, only the prevalence of post-traumatic stress disorder (PTSD) has been surveyed in population studies.
- The proportion of children with PTSD ranges from 0 to 0.4 per cent among pre-teen children and from 0.3 to 1.6 per cent among teenagers (Heier Vang, 2007; Kessler, 2012; Roberts, 2007; Ford, 2003).
- No figures are available for the lifetime prevalence of PTSD.
In the Norwegian specialist healthcare services, the proportions with diagnostic codes for adjustment disorders remained relatively stable during the period 2008 to 2016, with the exception of girls aged 15 – 17 years, as shown in Figures 5a and 5b.
- Among girls aged 15 – 17 years, the proportion with adjustment disorders rose from 1.2 per cent in 2011 to 1.8 per cent in 2016.
- Among boys aged 5 – 9 years and 10 – 14 years, and in girls aged 10 – 14 years, the proportions remained around 0.5 per cent each year.
We do not know the underlying cause of the increase in the use of the diagnosis among teenage girls, or the underlying types of adjustment disorders. Insufficient data are available to compare the findings with other studies, as these studies only present the prevalence for PTSD, rather than all types of adjustment disorders.
Figure 5a, b. Click to enlarge. Proportion of children per 1,000 diagnosed with adjustment disorder (ICD-10 code F43) during the period 2008 to 2016, by gender and age category. Background data: Norwegian Patient Registry.
Eating disorders are very rare among children, but are more common among teenagers.
- In population studies of children, the prevalence lies between 0 and 0.2 per cent (Heier Vang, 2007; Merikangas, 2010b; Ford, 2003).
- Among teenagers, prevalence estimates range from 0.2 to 1.1 per cent (Kessler, 2012; Merikangas, 2010b; Roberts, 2007; Ford, 2003).
- It is estimated that 2.7 per cent of teenagers have suffered from an eating disorder during their lifetime (Merikangas, 2010a).
Figure 6 shows the proportions diagnosed with an eating disorder by the Norwegian specialist health service during the period 2008 to 2016.
- For girls, the proportions were low for those under 15 years, but in the age group 15 – 17 years, there was an increase from 0.5 per cent in 2008 to 0.7 per cent in 2016. These figures correspond with the findings of population studies.
- Very few boys were diagnosed with an eating disorder: the proportions were below 0.1 per cent for all age groups among boys.
Figure 6. Click to enlarge. Proportion of children per 1,000 diagnosed with an eating disorder (ICD-10 code F50) during the period 2008 to 2016, by gender and age category. Background data: Norwegian Patient Registry.
The prevalence of intellectual disability among the population is not well-studied, and the registry data that are available for the condition are inadequate.
- In two population surveys from the United States, the prevalences among children were calculated at 0.7 per cent and 1.3 per cent respectively (Boyle, 2011; Van Naarden Braun, 2015).
- The actual prevalence is probably slightly higher. One would normally expect between 2.5 and 3 per cent of the population to have an IQ below 70, which is part of the definition of the condition. However, some of these people will not have a definite disability and will therefore not qualify for the diagnosis. In other cases, intellectual disability is not diagnosed because the divergent development can be explained using other, more specific diagnoses.
- In Norway, 60 – 80 children are born with Down’s syndrome every year, which is one of the single most important causes of intellectual disability (NIPH, 2017). The number of pregnancies with Down’s syndrome is rising as a result of the increasing age of mothers but the number of births has remained stable. This is because approximately 90 per cent of pregnancies with Down’s syndrome are terminated.
Hyperkinetic disorder (ADHD)
Hyperkinetic disorder (ADHD) is the most common developmental disorder. However, estimates of prevalence among children and adolescents vary greatly.
- In European population studies, prevalence ranges from 1.7 to 2.6 per cent (Heier Vang, 2007; Wichstrøm, 2012; Ford, 2003).
- In US population studies, prevalence ranges from 0.9 per cent to 9.9 per cent (Kessler, 2012; Costello, 2003; Angold, 2002; Merikangas, 2010b; Roberts, 2007). The high prevalence of ADHD diagnoses in the United States is partly due to the fact that the DSM-IV classification (APA, 2000) has been used for diagnostic purposes. This permits ADHD diagnoses based on attention deficit alone and does not require any hyperactivity or impulsiveness to be present.
- A meta-analysis dating from 2014 which included studies from around the world estimated the average prevalence of ADHD among children of school age to be around 5 per cent (Polanczyk, 2014).
- In Norway, the prevalence of ADHD is estimated to be 3.4 per cent among 12-year-olds but there are considerable variations between counties (Suren, 2013). These variations are probably due to different diagnostic practices.
The use of ADHD diagnoses by the Norwegian specialist health service is shown in Figures 7a and 7b, while the proportions who have received treatment with central stimulants for ADHD are shown in Figure 8.
- During the period 2008 to 2016, the proportions with the diagnosis remained relatively stable among both sexes and in all age groups.
- Many children with ADHD are monitored by the primary healthcare service after diagnosis. Therefore, the actual proportions with the diagnosis are higher than the proportion diagnosed by the specialist healthcare service each year.
The proportions of children and adolescents over ten years of age who receive treatment for ADHD varies between 3.5 and 4 per cent of boys and 1.5 per cent of girls. Gender differences in the use of therapeutic drugs correspond to gender differences in the use of the diagnosis.
Figure 7a, b. Click to enlarge. Proportion of children per 1,000 diagnosed with ADHD (ICD-10 code F90) during the period 2008 to 2016, by gender and age category. Background data: Norwegian Patient Registry.
Figures 8a and b above show proportion of children per 1,000 who have received drugs for the treatment of ADHD at least once during the ten-year period 2007 to 2016.
Pervasive developmental disorders (autism spectrum disorders)
For autism spectrum disorders, the prevalence of diagnosed cases has increased considerably in all Western countries over the past couple of decades.
- Previous estimates in Norway have indicated that 0.9 per cent of all children have been diagnosed with autism by the age of 12 (Suren, 2013).
- Recent estimates from other countries have been even higher, at 2.5 per cent among 6-12 year olds in Stockholm County, Sweden (Idring, 2015), 1.5 per cent among 10-year olds in Denmark (Atladottir, 2015) and 1.5 per cent among 8-year olds in the United States (Christensen, 2016).
As Figures 9 and 9b show, the proportions with the diagnosis increased in all age groups and among both sexes in Norway during the period of 2008 to 2016, but the increase was most pronounced for boys and the oldest girls (15 – 17 years of age).
- Among boys, the proportions in 2016 were 0.6 per cent in the age group 5 – 9 years and between 0.8 per cent and 0.9 per cent in the age groups 10 – 14 and 15 – 17 years.
- Among girls, the proportions in 2016 were around 0.2 per cent in the age groups 5 – 9 and 10 – 14, and around 0.4 per cent in the age group 15 – 17.
Figure 9. Click to enlarge. Proportion of children and adolescents per 1,000 diagnosed with autism spectrum disorders (ICD-10 code F84) during the period 2008 to 2016, by gender and age category. Background data: Norwegian Patient Registry.
The prevalences for ASD are low compared with the studies we have reviewed. This is because some are followed up by the primary health service and the Educational and Psychological Counselling Service in the municipalities after the diagnosis has been made.
It is worth noting that the proportion of teenage girls diagnosed with autism is increasing. This could indicate that more cases of autism spectrum disorders are being identified among girls than was previously the case, but also that it often occurs at a relatively late age.
Other developmental disorders
For language disorders, learning difficulties, and motor delays, prevalence estimates vary considerably between studies depending on the criteria used to define the conditions concerned. The registry data that are available for these developmental disorders are of insufficient quality.
- Questionnaire data from the Norwegian Mother & Child Cohort Study show that 8 per cent of children are behind their expected normal language development at the age of three, and 9.5 per cent are behind at age five (Zambrana, 2014).
- A large study from the United States which included both questionnaires and clinical interviews of 5-year olds found that 7.4 per cent met the criteria for a language disorder (Tomblin, 1997).
- A US survey based on telephone interviews found that 7 per cent of children aged 3 – 17 years had learning difficulties (Boyle, 2011). In studies which tested children's reading skills directly, it was found that the criteria for dyslexia were met in 18 – 22 per cent of boys and 8 – 13 per cent of girls of school age (Rutter, 2004). The Norwegian data that are available concerning the prevalence of learning difficulties are inadequate.
- For motor delays, little is known about the prevalence and progression of the child population as a whole, as motor difficulties have usually only been studied in relation to other specific conditions.
The prevalence of behavioural disorders has been estimated in a number of population studies of children and adolescents.
- For oppositional defiant disorder (ODD), which is the mildest form, the prevalence ranges from 1.8 per cent to 2.9 per cent (Heier Vang, 2007; Wichstrøm, 2012; Kessler, 2012; Costello, 2003; Angold, 2002; Roberts, 2007; Ford, 2003). Among teenagers, it is estimated that 11.5 – 12.5 per cent have had oppositional defiant disorder during their lifetime (Merikangas, 2010a; Kroes, 2001).
- As regards more severe behavioural disorders, known as “conduct disorders", prevalence varies between 0.5 per cent and 5.4 per cent (Heier Vang, 2007; Wichstrøm, 2012; Merikangas, 2010a; Kessler, 2012; Costello, 2003; Angold, 2002; Roberts, 2007; Ford, 2003).
- In the Norwegian specialist healthcare services, use of the diagnosis declined for both sexes and most age groups during the period 2008 to 2016. Many cases of behavioural disorder have not yet been diagnosed, or are covered by other diagnoses.
Only a few population-based studies have been carried out concerning the prevalence of tic disorders among children.
- In a Swedish study which included children of all ages, the prevalence was estimated at 0.6 per cent for Tourette's syndrome, 1.3 per cent for chronic motor and vocal tics and 4.8 per cent for transient tics (Khalifa, 2005).
- In the "Barn i Bergen" study (Children in Bergen Study), the prevalence of Tourette’s syndrome was estimated at 0.2 per cent among 7 – 9 year olds (Heier Vang, 2007).
The proportions registered with Tourette's syndrome by the specialist health service are of the same order of magnitude as figures from the population studies.
- Among boys, the proportions vary between 0.1 per cent and 0.4 per cent, while very few girls are registered with the diagnosis.
Suicide, attempted suicide and self-harm
Suicide among children under the age of 15 is extremely rare. Attempted suicide can occur among both children and adolescents, but self-harm is most prevalent among adolescents. In many studies of self-harm, it is unclear whether or not the adolescents have harmed themselves with suicidal intent. There is therefore some uncertainty over the extent of self-harm and the extent to which it represents an actual suicide attempt.
- Figures from Ungdata in 2014 showed that 15.3 per cent in the age group 13 – 19 years responded that they had self-harmed during the previous 12 months (NOVA, 2015).
- A summary of 52 studies from around the world found that an average of 18 per cent of adolescents had self-harmed during their lifetime (Muehlenkamp, 2012).
- Another international study from seven different countries covering 30,000 adolescents aged 14 – 17 found that 14 per cent of girls and 4 per cent of boys had self-harmed (Madge, 2008).
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Quality of life and mental health among children and adolescents in Norway. In: Public Health Report - Health Status in Norway [online document]. Oslo: Institute of Public Health [updated (insert date); read (insert date)]. Available from: [insert link]
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