Oiling a neglected wheel: an investigation of adolescent internalising problems in rural South Australia

Despite a paucity of research, adolescents living in rural areas appear to have a heightened risk for developing a mental health problem compared with their urban counterparts. The main objectives of this study were to contribute to building an evidence base of prevalence rates and determinants of internalising problems of adolescents in rural South Australia. A multidimensional Process Model was used as theoretical framework to enable an investigation of the various determinants from individual, family and community domains; specifically, the contribution of self-esteem, parental acceptance and elements of social capital at an individual level (ie participation in the local community and proactivity in a social context represented structural social capital, and feelings of trust and safety, and neighbourhood connections represented cognitive social capital).

In this cross-sectional prospective study, a total of 388 Year 9 (2nd year of secondary school) students (208 females, 180 males) aged 13-15 years (mean age = 14.2 years) participated from 11 high schools within the Country Health South Australian area. These adolescents completed a battery of self-reported measures online at school.

The results demonstrated that the adolescents experienced a 'normal' level of self-esteem and a 'moderate' level of perceived parental acceptance. The level of social capital was considered 'low' and the adolescents experienced a 'moderate' level of internalising symptoms. Based on the mean score of the Revised Child Anxiety & Depression Scales (RCADS), 25% of the adolescents experienced internalising symptoms ranging in severity from mild to severe, with no significant differences between males and females. Approximately 13% were considered above the clinical threshold, with 4% reporting experiencing severe symptoms. Relationships between all measures were investigated using Pearson product-moment correlations coefficients and associations between self-esteem, parental acceptance, social capital, and internalising problems were assessed using multivariate linear regressions. Both parental acceptance and social capital were found to predict self-esteem. Parental acceptance was also significantly associated with social capital. The linear contribution of self-esteem, parental acceptance and social capital was significantly related to internalising problems. Approximately 33% of the variance in internalising problems could be accounted for by the combination of the three predictors; however, self-esteem and parental acceptance were the significant contributors to the prediction of internalising problems. Social capital was not a significant predictor of internalising problems.

The present study only begins to contribute to the lack of existing data on the mental health status of adolescents from rural areas of South Australia. Greater research is needed to enhance understanding of this overlooked population and also assist in providing evidence-based guidelines in establishing priorities for newly appointed Federally funded youth services in rural Australia. In light of the concerning rates of internalising problems demonstrated by the present study, coupled with the fact that young people from rural areas were not considered in previous National Mental Health Surveys, it seems timely to highlight the importance of including as many Australians as possible from rural and remote areas, in the approaching, subsequent National survey. This will provide a more accurate evidence-based representation of Australia's adolescent population to inform policy and facilitate the implementation of relevant strategies.