Terryann Clark

The Health and Well-Being of Transgender High School Students: Results From the New Zealand Adolescent Health Survey (Youth'12)

PURPOSE To report the prevalence of students according to four gender groups (i.e., those who reported being non-transgender, transgender, or not sure about their gender, and those who did not understand the transgender question), and to describe their health and well-being. METHODS Logistic regressions were used to examine the associations between gender groups and selected outcomes in a nationally representative high school health and well-being survey, undertaken in 2012. RESULTS Of the students (n = 8,166), 94.7% reported being non-transgender, 1.2% reported being transgender, 2.5% reported being not sure about their gender, and 1.7% did not understand the question. Students who reported being transgender or not sure about their gender or did not understand the question had compromised health and well-being relative to their non-transgender peers; in particular, for transgender students perceiving that a parent cared about them (odds ratio [OR], .3; 95% confidence interval [CI], .2-.4), depressive symptoms (OR, 5.7; 95% CI, 3.6-9.2), suicide attempts (OR, 5.0; 95% CI, 2.9-8.8), and school bullying (OR, 4.5; 95% CI, 2.4-8.2). CONCLUSIONS This is the first nationally representative survey to report the health and well-being of students who report being transgender. We found that transgender students and those reporting not being sure are a numerically small but important group. Transgender students are diverse and are represented across demographic variables, including their sexual attractions. Transgender youth face considerable health and well-being disparities. It is important to address the challenging environments these students face and to increase access to responsive services for transgender youth.

Emotional resilience: risk and protective factors for depression among alternative education students in New Zealand.

A total of 268 alternative education students from New Zealand were surveyed to examine risk and protective factors for depression within the social environment. Twenty-eight (35.4%) of the girls and 31 (21.1%) of the boys had cut-off scores that indicated a high likelihood of significant psychopathology from depression. Multivariate analysis demonstrated that family and peer connections were protective against depression. High levels of poverty, witnessing violence at home, and experiencing bullying at school were significant risk factors for depression.

Adolescents' perceptions of a health survey using multimedia computer-assisted self-administered interview

Objective: To ascertain young peoples perceptions of an adolescent health survey when administered by multimedia computer assisted self‐administered Interview (M‐CASI) through analysis of (1) questionnaire item responses and (2) focus group interviews.

Do Schools Influence Student Risk-taking Behaviors and Emotional Health Symptoms?

PURPOSE Many schools engage in health promotion, health interventions, and services aimed at improving the health and well-being outcomes for students. The purpose of this study was to examine the effects of schools on student health risk-taking behaviors and depressive symptoms. METHOD A nationally representative sample (n = 9,056) of students from 96 secondary schools completed a health and well-being survey using Internet Tablets that included questions on school climate, health risk-taking behaviors, and mental health. Teachers (n = 2,901) and school administrators (n = 91) completed questionnaires on aspects of the school climate which included teacher well-being and burnout, the staff work environment, health and welfare services for students, and school organizational support for student health and well-being. Multilevel models were used to estimate school effects on the health risk-taking behaviors and depression symptoms among students. RESULTS Schools where students reported a more positive school climate had fewer students with alcohol use problems, and fewer students engaging in violence and risky motor vehicle behaviors. Schools where teachers reported better health and welfare services for students had fewer students engaging in unsafe sexual health behaviors. Schools where teachers reported higher levels of well-being had fewer students reporting significant levels of depressive symptoms. CONCLUSIONS More positive school climates and better school health and welfare services are associated with fewer health risk-taking behaviors among students. However, the overall school effects were modest, especially for cigarette use and suicidal behaviors.

Sexual attraction, depression, self-harm, suicidality and help-seeking behaviour in New Zealand secondary school students

Objective: To describe the sexual attractions of New Zealand secondary school students and investigate the associations between sexual attraction and self-reported depression, self-harm, suicidality and help-seeking behaviour. Method: Multiple logistic regression was used to examine the associations between sexual attraction and depressive symptoms, suicidality, self-harming and help-seeking behaviours in a nationally representative secondary school health and well-being survey, undertaken in 2007. Results: Of the students surveyed, 92% were attracted to the opposite sex, 1% to the same sex, 3% to both sexes, 2% were not sure and 2% were attracted to neither sex. Students who were attracted to the same or to both sexes consistently had higher prevalence estimates of depression (p = < 0.0001), suicidality (p = < 0.0001) and self-harming (p = < 0.0001). Odds ratios were highest for students who reported they were attracted to both sexes for depressive symptoms (OR 3.7, 95%CI 2.8–4.7), self-harm (OR 5.8, 95%CI 4.4–7.6) and attempted suicide (OR 7.0, 95%CI 5.2–9.4). Students not exclusively attracted to the opposite sex were more likely to report having seen a health professional for an emotional worry and were more likely to have difficulty accessing help for emotional concerns. Conclusions: The study findings highlight significant mental health disparities faced by students attracted to the same or both sexes, with those attracted to both sexes appearing particularly vulnerable. There is a vital need to ensure primary care and mental health services have the capacity and capability to screen and provide appropriate responsive care for youth who are attracted to the same or both sexes.

Stability and change in the mental health of New Zealand secondary school students 2007–2012: Results from the national adolescent health surveys

Objective: To describe the self-reported mental health of New Zealand secondary school students in 2012 and to investigate changes between 2007 and 2012. Methods: Nationally representative health and wellbeing surveys of students were completed in 2007 (n=9107) and 2012 (n=8500). Logistic regressions were used to examine the associations between mental health and changes over time. Prevalence data and adjusted odds ratios are presented. Results: In 2012, approximately three-quarters (76.2%, 95% CI 74.8–77.5) of students reported good overall wellbeing. By contrast (also in 2012), some students reported self-harming (24.0%, 95% CI 22.7–25.4), depressive symptoms (12.8%, 95% CI 11.6–13.9), 2 weeks of low mood (31%, 95% CI 29.7–32.5), suicidal ideation (15.7%, 95% 14.5–17.0), and suicide attempts (4.5%, 95% CI 3.8–5.2). Between 2007 and 2012, there appeared to be slight increases in the proportions of students reporting an episode of low mood (OR 1.14, 95% CI 1.06–1.23, p=0.0009), depressive symptoms (OR 1.16, 95% CI 1.03–1.30, p=0.011), and using the Strengths and Difficulties Questionnaire - emotional symptoms (OR 1.38, 95% CI 1.23–1.54, p<0.0001), hyperactivity (OR 1.16, 95% CI 1.05–1.29, p=0.0051), and peer problems (OR 1.27, 95% CI 1.09–1.49, p=0.0022). The proportion of students aged 16 years or older reporting self-harm increased slightly between surveys, but there was little change for students aged 15 years or less (OR 1.29, 95% CI 1.15–1.44 and OR 1.10, 95% 0.98–1.23, respectively, p=0.0078). There were no changes in reported suicidal ideation and suicide attempts between 2007 and 2012. However, there has been an improvement in self-reported conduct problems since 2007 (OR 0.78, 95% CI 0.70–0.87, p<0.0001). Conclusions: The findings suggest a slight decline in aspects of self-reported mental health amongst New Zealand secondary school students between 2007 and 2012. There is a need for ongoing monitoring and for evidence-based, accessible interventions that prevent mental ill health and promote psychological wellbeing.

Health and well-being of secondary school students in New Zealand: Trends between 2001, 2007 and 2012

To describe indicators of health and well‐being for New Zealand secondary school students; explore changes between 2001, 2007 and 2012; and compare these findings to international estimates.

The Prevalence of Chronic Health Conditions Impacting on Daily Functioning and the Association With Emotional Well-Being Among a National Sample of High School Students

PURPOSE This study aims to describe the prevalence of self-reported chronic health conditions among high school students in New Zealand, the extent to which the condition impacts on their activities and socialization, and to explore the association between the level of impact of the illness or disability and the emotional well-being of students with chronic health conditions. METHODS A two-stage cluster sample of 9,107 students (Years 9-13) from 96 New Zealand high schools participated in a 2007 health survey using internet tablets. Students were asked about any chronic illness or disabilities lasting more than 6 months, the impact of the illness or disabilities on their daily activities and socialization, and their depressive symptoms (RADS-SF) and emotional well-being (WHO-5). RESULTS Almost one in five students (18%) reported a chronic health condition. Among them, 28% reported an impact of their illness or disability on their activities, and 8% reported an impact on their ability to socialize. High levels of depressive symptoms were found among students with chronic health conditions reporting that their illness or disability impacts their activities (18%) or their ability to socialize (40%), and this was significantly higher than among students without chronic health conditions (10%). CONCLUSIONS Our findings suggest that there is a large group of adolescents with chronic health conditions for whom their illness or disability has an impact on their daily activities and ability to socialize with their peers. These students are more likely to experience emotional distress and require support and opportunities for healthy youth development.

Bystander Intervention, Bullying, and Victimization: A Multilevel Analysis of New Zealand High Schools.

This study examines the association between schools and student bullying behaviors and victimization among a nationally representative sample (N = 9,107) of New Zealand high school students. In particular, the study sought to explore the role of characteristics of schools and school culture with respect to bystander behavior, while controlling for individual student factors related to victimization and bullying behaviors. Results indicated that a total of 6% of students report being bullied weekly or more often and 5% of students reported bullying other students at least weekly. Results of multilevel analyses suggested that schools characterized by students taking action to stop bullying were associated with less victimization and less reported bullying among students. In contrast, in schools where students reported teachers take action to stop bullying, there was no decline in victimization or bullying. Overall, these findings support whole-school approaches that aid students to take action to stop bullying.

Prevalence of severe obesity among New Zealand adolescents and associations with health risk behaviors and emotional well-being.

OBJECTIVE To describe the prevalence of severe obesity among New Zealand young people attending secondary school and the associations of severe obesity with health risk behaviors and emotional well-being. STUDY DESIGN A random sample of 9107 secondary school students in New Zealand participated in a 2007 health survey. Participants had their height and weight measured and answered an anonymous survey on multiple aspects of their health and well-being. RESULTS Overall, 2.5% of students met the International Obesity Task Force definition of severe obesity. Students with severe obesity had more weight-related concerns, were more likely to have used unhealthy weight control strategies, and were more likely to experience bullying compared with healthy weight students. For example, students with severe obesity were 1.7 times more likely to have been bullied at school (95% CI 1.2-2.7) and 1.9 times more likely to vomit for weight loss (95% CI 1.1-3.3) than were healthy weight students. Indicators of emotional well-being and most health risk behaviors were similar among young people with severe obesity and a healthy weight. CONCLUSIONS Clinicians who work with young people with severe obesity should prioritize discussing issues of bullying and healthy weight control strategies with families and their children.