Temporal trends in adolescents' self-reported psychosomatic health complaints from 1980-2016: A systematic review and meta-analysis

Exploring associations between subjective well-being and personality over a time span of 15-18 months: a cohort study of adolescents in Sweden

Introduction

Subjective well-being (SWB) is a contributing factor for building resilience and a resource for positive outcomes, e.g. study achievement and work performance. Earlier studies have examined associations between and prospective effects of personality traits on SWB, but few addressed the role that SWB plays in formation of personality over time. The purpose of our study was to examine associations and prospective effects of SWB on personality traits and vice versa in a cohort sample of secondary school students in Sweden who completed self-reported measures of SWB and personality traits at baseline (N = 446, 76% females) and at 15–18 month follow-up (N = 283, 71% females).

Methods

SWB was defined and measured by the WHO-5 Well-being Index and the Satisfaction with Life Scale. The Big Five Inventory was used to measure personality traits. Autoregressive models were used to analyse associations and potential prospective effects of SWB on personality traits and vice versa.

Results

Low levels of neuroticism and high levels of extraversion, conscientiousness and agreeableness were associated with high levels of SWB at baseline and follow-up. The association between SWB and neuroticism was notably strong. We found high statistically significant rank order stability across the two time points for all measures of personality traits with stability effects, derived from the autoregressive models, ranging from .199 for extraversion to .440 for neuroticism. Stability for SWB was statistically significant across the two time points and ranged from .182 for well-being to .353 for life satisfaction. SWB had a prospective effect on agreeableness only. None of the personality traits had any significant prospective effects on SWB.

Conclusions

The present findings indicate that although correlated, bidirectional prospective effects between personality traits and SWB could not be confirmed. Neuroticism displayed the strongest negative association with adolescents’ SWB. Schools are an appropriate setting to improve well-being, and allocating resources that reduce neuroticism is crucial, including structural interventions, policies for healthy school settings and teaching emotional regulation techniques.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00673-9.

Self-help interventions for young people with persistent physical symptoms: A systematic review

OBJECTIVE

Persistent physical symptoms are frequent among young people causing considerable social, psychological, and economic consequences. Easily accessible interventions adapted to non-specialized settings are needed. We aimed to systematically review randomized controlled trials on self-help interventions for young people with persistent physical symptoms compared to active or passive control groups. Our purpose was to 1) describe applied therapeutic approaches and content and 2) examine potential effects on symptom burden and psychosocial outcomes.

METHODS

We included randomized controlled trials on minimal contact self-help interventions for young people with persistent physical symptoms. Systematic literature searches in PubMed, Cochrane Central, Embase, and PsycINFO were conducted. Study selection, data extraction and quality assessment were performed independently by two reviewers. A narrative synthesis of the effects was performed.

RESULTS

We identified 11 studies on self-help interventions for young people. The methodological quality of the studies was generally low. Participants suffered from impairing fatigue, headache, abdominal pain, and musculoskeletal or multi-site pain. Applied therapeutic approaches were cognitive behavioral therapy, relaxation training, hypnotherapy, and written self-disclosure. Outcomes were diverse and mainly related to symptom burden, whereas psychosocial outcomes were only sporadically examined. Overall, evidence of effectiveness of self-help interventions in alleviating symptom burden was weak, and potential effects could not be linked to one specific theoretical approach.

CONCLUSION

Few self-help interventions of diverse content exist for young people with persistent physical symptoms. Rigorously designed studies that include recommended outcome domains assessed by aligned measures are needed to determine and compare the clinical value of such interventions.

Trajectories of risky driving among emerging adults with their mental and psychosomatic health predictors in the 12th grade

OBJECTIVE

To identify trajectory classes of risky driving among emerging adults and examine predictive associations of depressive and psychosomatic symptoms in the 12th grade with the identified trajectory classes.

METHODS

Data were from the last year in high school (12th-Grade - Wave 3 [W3]) and years 1-4 after high school (Waves 4-7 [W4-7]) of the NEXT Generation Health Study, a nationally representative study starting with 10th grade (2009-2010). We measured risky driving with the 21-item Checkpoints Self-Reported Risky Driving Scale (C-RDS). Using C-RDS data from W3-7, the latent class growth modeling (LCGM) was used to identify risky driving trajectory classes. Independent variables were W3 depressive symptoms and W3 psychosomatic symptoms. Covariates included family affluence and urbanicity. The LCGM was conducted with SAS PROC Traj. The multinomial logistic regressions were used to examine the associations between the trajectory classes and independent variables, taking complex survey sampling features into account.

RESULTS

Three risky driving trajectories were identified: low (N = 583, 21.43%, weighted and hereafter), medium (N = 1423, 59.22%), and high (N = 389, 19.35%) risky driving classes. Compared to the low risky driving class, one unit increase in W3 depressive symptoms was significantly associated with a higher likelihood of belonging to the medium (adjusted odds ratio [AOR] = 1.04, 95% CI 1.01, 1.07) and the high (AOR = 1.05, 95% CI 1.02, 1.08) risky driving classes, respectfully, when controlling for the covariates. Likewise, compared to the low risky driving class, one unit increase in W3 psychosomatic symptoms was significantly associated with a higher likelihood of belonging to the medium (AOR = 1.06, 95% CI 1.00, 1.13) and the high (AOR = 1.10, 95% CI 1.04, 1.16) risky driving classes, respectively, when controlling for the covariates.

CONCLUSIONS

High school students with depressive and psychosomatic symptoms were at higher risk of engaging in risky driving in the immediate years after leaving high school. These findings suggest that prevention programs that incorporate screening, referral to treatment, and treatment of mental and psychosomatic symptoms in high school may be important opportunities to reduce risky driving among youth as they transition from adolescence to emerging adulthood.

Cross-national trends of chronic back pain in adolescents: results from the HBSC study, 2001-2014

Chronic back pain is a common problem that negatively impacts the wellbeing of many adolescents. Prior research suggests that the prevalence of chronic back pain has increased over the last decades, but research on this issue is scarce, single country-based, and has yielded inconsistent results. This study aimed to examine trends in the prevalence of chronic back pain over time in adolescents aged 11, 13 and 15, using data from the Health Behavior in School-aged Children (HBSC) survey. We conducted a secondary analysis of data from 650,851 adolescents, retrieved from four waves (2001/02, 2005/06, 2009/10 and 2013/14) of HBSC data from 33 countries or regions. The prevalence of back pain was higher (1) in each successive survey over time (18.3% in 2001/02, 19.3% in 2005/06, 20.4% in2009/10 and 21.6% in 2013/14), (2) in girls (21.9%) compared to boys (17.8%), and (3) in older adolescents compared to younger ones (14.5% in 11-year-olds, 19.6% in 13-year-olds and 25.5% in 15-year-olds). The increase in prevalence from 2001/02 to 2013/14 was more marked in older girls compared to younger girls, and in older boys compared to younger boys, and it ranged between 1% for 11-year-old boys and 7% for 15-year-old girls. More resources should be allocated to the prevention and treatment of chronic back pain in adolescents, especially for older girls.

Electronic media use and symptoms of depression among adolescents in Norway

BACKGROUND

The purpose of this study was to examine the association between electronic media use, including use of social media and gaming, and symptoms of depression, and whether gender or having friends moderated these associations.

METHODS

This study was based on self-reported cross-sectional data from the Ungdata survey, conducted in 2018 by the Norwegian Social Research (NOVA) Institute in cooperation with seven regional drug and alcohol competence centres. The target group comprised 12,353 15-16 years old adolescents. Binominal logistic regression was used to analyse the association between electronic media use and symptoms of depression.

RESULTS

The odds of having symptoms of depression were higher for those who used social media more than 3 hours per day (OR: 1.60, 95% CI: 1.43-1.80), compared to those who used social media 3 hours or less per day. Additionally, the odds of having symptoms of depression was higher for those who used more than 3 hours on gaming per day (OR: 1.57, 95% CI: 1.36-1.80), compared to those who used 3 hours and less on gaming per day after adjustment for potential confounders. There were no interaction effects between social media and gaming use with symptoms of depression. Neither were the associations between social media use and gaming with symptoms of depression moderated by gender or having friends.

CONCLUSIONS

The odds of having symptoms of depression were significantly higher for adolescents with a more frequent use of electronic media.

A Global Decline in Adolescents' Subjective Well-Being: a Comparative Study Exploring Patterns of Change in the Life Satisfaction of 15-Year-Old Students in 46 Countries

There is a growing body of research that demonstrates declines in subjective well-being and increases in mental health problems among children and young people in recent decades. However, there is little comparative research examining changes in adolescents' life satisfaction (LS) across a large number of countries, and critically, how this differs across sociodemographic groups. This study addresses this question by investigating changes in the LS of 15-year-old students between 2015 and 2018, with particular attention given to differences by gender, socio-economic status, immigrant background and urbanity. Data for this study come from the Programme for International Student Assessment (PISA). Due to the skewed nature of LS scale variables, the current study includes both mean levels of LS in a 0 to 10 scale, and the proportion of students reporting low LS (5 points or less). Linear regression models were used. Results demonstrate a global decline in mean levels of LS in 39 out of the 46 countries. In most countries, mean LS declined more among girls than among boys. Mean LS declined more, and the proportion of students reporting low LS increased more, among non-immigrant students and those of higher SES in the majority of countries. Findings regarding rural or urban communities were mixed. We advise that heterogeneity across all sociodemographic groups needs to be accounted for in public policy efforts to increase LS among young people.

Predictors of Adolescent Depressive Symptoms

The present study expands the existing literature and supplements today’s knowledge on the relationship between personal, psychosocial and lifestyle factors and depressive symptoms among adolescents. The study aimed to investigate the variety of depressive symptoms predictors—personal resources, adverse school and family, health, lifestyle-related (sense of coherence, self-esteem, school involvement, negative acts at school, family stress and violence, psychosomatic health complaints, physical activity, smoking, alcohol) as well as gender, employing hierarchical linear regression analysis in a large representative sample of adolescents (N = 2212) in Kaunas, Lithuania. Four blocks of predictors were employed in hierarchical linear regression analysis. In the final model 64.9% of depressive symptoms were explained by all the predictors. Sense of coherence was the strongest predictor of depressive symptoms (standardized regression coefficient β = −605, p < 0.001 in the first model and β = −263, p < 0.001 in the final model after adjustment for all other independent variables) and accounted for 36.6% of variance. In conclusion, this study supports the notion that depressive symptoms among adolescents have multifactorial origins with many predictors showing significant effect seizes. Therefore, high sense of coherence and self-esteem, school involvement, higher levels of physical activity would be protective and influence lower levels of depressive symptoms among adolescents. Exposure to negative acts at school and negative experiences in the family, psychosomatic health complaints, smoking would increase the probability of depressive symptoms. Girls are more prone to depression as compared to boys.

Sadness and Other Health Complaints among Swedish Adolescents: A Cross-Sectional Study

Health complaints are increasing among adolescents and are recognized as a global public health issue. Health complaints are an indicator for subjective ill-being, but little is known about the relationship between sadness and other health complaints. The aim of this study was to investigate sadness and other health complaints among Swedish adolescents. A survey with a cross-sectional design was completed by adolescents (n = 1489, 15-17 years old) in the south of Sweden. A logistic regression analysis was used to analyze the relationship between sadness and other health complaints. The result show that sadness and other health complaints were common among adolescents, and sadness was related to health complaints (headache (OR: 1.58), sleeping difficulties (OR: 2.00), reduced appetite (OR: 1.43), tension (OR: 2.44), and concentration difficulties (OR: 2.75)). When adolescents express sadness or other health complaints it is important to reflect on what these complaints are an expression of, and take into account the body as physical and psychological intertwined. This might entail person-centered support that hopefully leads to an improvement in adolescents' well-being. Future research that profoundly highlights adolescents' existential health is needed.

Mortality trends for young adults in Sweden in the years 2000-2017

Aim:

Mental health problems in young people seem to be on the rise and more so in Sweden than in other locations. The aim was to compare the development of mortality rates for young adults in Sweden with Western Europe in total.

Methods:

Young adults were defined as individuals aged 20–34 years and the study period was 2000–2017. Mortality data were derived from the Institute of Health Metrics and Evaluation.

Results:

During the period 2000–2017, the mortality rate in young adults in Sweden stayed about the same, while in Western Europe as a whole the mortality rate decreased by 42%. The leading explanation for the unfavourable Swedish development was deaths due to drug use, mainly opioids, which increased by 60% during this period. The other major causes of death decreased both in Sweden and Western Europe, but decreased more slowly in Sweden. The differences in the rate of decrease between Sweden and Western Europe were for self-harm (27%), transport injuries (12%), unintentional injuries (31%) and for neoplasms (23%). The unfavourable development in Sweden resembled the development in the USA.

Conclusions:

The risks of four of the five leading causes of death in this age group were affected by the individuals’ social conditions. The unfavourable mortality development in young adults in Sweden was mainly due to substance use. A contributing cause might be the change in the Swedish healthcare system that introduced competition between providers, which might have encouraged providers to prescribe opioids.

Trends in the utilization of youth primary healthcare services and psychological distress

Background

Psychological distress among young people is increasing in Northern Europe. According to established healthcare utilization theory, this will create a greater need for youth primary healthcare and subsequently lead to more help-seeking behavior by distressed young people. The aim of this study was to investigate the association between the use of youth primary healthcare services and psychological distress in times of increasing mental health problems and increased service need.

Methods

This study consisted of five waves of repeated annual cross-sectional data collected from young people (aged 13–19) living in Norway between 2014 and 2018 (n = 368,579). Population-weighted and design-adjusted generalized linear regression with a log-link was used to examine the use of youth primary healthcare services over time.

Results

We found that a large proportion of young people use primary healthcare services and that young people with high levels of psychological distress use primary healthcare services twice as much as their peers with low levels of psychological distress. In addition, between 2014 and 2018 both psychological distress and primary healthcare service utilization increased: psychological distress increased by 5% and total primary healthcare service use increased by 500 consultations per 1000 young people. Overall, psychological distress had a conditional association with youth primary healthcare service use and could account for between 16 and 66% of the change in the use of services between 2014 and 2018, depending on the service type. However, the absolute increase seen in the use of primary healthcare services was mainly driven by young people with low levels of psychological distress as opposed to young people with high psychological distress. This suggest a converging trend.

Conclusions

Our findings suggest that there might be serious barriers between need and help-seeking behavior for young people with high levels of psychological distress and that the pattern of utilization among young people with lower distress may indicate overuse, possibly as an inadvertent consequence of a newly introduced school absence policy. While further research is needed to confirm these findings, our work may inform healthcare providers and policy makers about primary healthcare utilization trends among young people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06124-w.

Experiences with using an idiographic assessment procedure in primary mental health care services for adolescents

Purpose: This article aims to explore counsellor experiences using an idiographic assessment procedure implemented in adolescent mental health services. The procedure, Assert, is based on asking the adolescents the question “What matters to you?” to define important topics to address in treatment.

Methods: Focus groups and interviews were conducted with counsellors who used Assert (N = 27), and the data were analysed with thematic analysis.

Results: Five themes were identified: (a) “What Matters to You?” (b) “Professional Responsibility,” (c) “Empowering the Adolescent,” (d) “Practical Utility of Assert in Treatment,” and (e) “The Implementation of Assert.” Each theme had a number of associated sub-themes.

Conclusions: Assert was perceived by the counsellors as enhancing collaboration and conveying to the adolescents that the counsellors took their concerns seriously. It also provided structure by giving the sessions a concrete focus. However, some counsellors found it difficult to surrender control to the adolescents, and finding a balance between helping and directing the adolescents to define topics could be challenging at times. Assert was generally considered a useful and simple way to assess adolescents’ concerns, and it was accepted by the counsellors as a positive contribution to their existing methods.

Student perspectives on health dialogues: how do they benefit?

The vast majority of students in Sweden are healthy and live good lives, but rising health problems and declining academic performance pose risks to the country’s student population. School health services (SHS) in Sweden have a long tradition of hosting health dialogues (HD) with students to support their health and its repercussions on their learning.

Purpose: To describe experiences from 6- to 16-year-old students participating in the health dialogue in school.

Method: Descriptive qualitative design. Data were collected from 734 open-ended responses on a questionnaire distributed among students ranging in age from 6 to 16. The data were subjected to qualitative content analysis.

Findings: The analysis identified five categories: Important to identify health and health problems, School nurse, a key profession, School environment important for both health and learning, Importance of health screening and Important to have a healthy lifestyle. The findings revealed that students aged 6 to 16 years old consider health and health problems, school environment, health screening and healthy lifestyle to be important areas for health and learning School nurses were identified as key persons in HD and for student’s experience of health and learning.

Conclusion: HD is an opportunity for students to participate and influence decisions concerning their health and education, to actively engage in their own health and learning in areas that affect them for example, the school environment.

Ten-year changes in the psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence of 18-year-old males: a Finnish population-based time-trend study

We studied Finnish 18-year-old males attending obligatory military call-up assessments in 1999 (n = 2340) and 2009 (n = 4309) on time-trend changes in psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence. Subjects filled in questionnaires, including the Young Adult Self-Report (YASR) for psychopathology and the Orientation to Life Questionnaire (SOC-13) for sense of coherence. The prevalence of minor mental health problems in the last 6 months decreased from 22.3% in 1999 to 18.6% in 2009 (OR 0.8, 95% CI 0.7-0.9), whereas severe mental health problems remained stable. Suicidal thoughts decreased from 5.7 to 3.7% (OR 0.6, 95% CI 0.5-0.8). The use of illicit drugs decreased from 6.0 to 4.7% (OR 0.8, 95% CI 0.6-0.95), but being drunk at least once a week increased from 10.3 to 13.4% (OR 1.3, 95% CI 1.0-1.5). Attention problems increased in YASR syndrome domains (mean score 2.9 vs 3.2, p < 0.001) and so did somatic complains (mean score 1.7 vs 1.9, p = 0.005). The SOC-13 scores remained stable. The percentage of males who had studied during the past 6 months increased from 91.4 to 93.4% (OR 1.3, 95% CI 1.1-1.6), while being employed decreased from 64.9 to 49.4% (OR 0.5, 95% CI 0.5-0.6). The positive findings included reductions in the prevalence of suicidal thoughts and the use of illicit drugs, but being drunk at least once a week increased. Self-reported somatic problems and attention problems increased. Despite changes in society and family structures, there were only minor overall changes in psychopathology.

Subjective Happiness and Sleep in University Students with High Myopia

Purpose: Recent investigations described a host of disadvantageous myopia comorbidities including decreased QOL, depression, and sleep problems. The present study evaluated mental status and habitual sleep in young subjects with myopia based on the reported association between myopic error and psychiatric profiles. Methods: This cross-sectional study surveyed 153 university students using a questionnaire containing the Pittsburgh Sleep Quality Index (PSQI), Subjective Happiness Scale (SHS), short morningness/eveningness questionnaire, and Hospital Anxiety and Depression Scale (HADS). Results: Participants were classified as having high myopia (n = 44), mild myopia (n = 86), or no myopia (n = 23). The SHS and HADS scores in this cohort were significantly worse in the high myopia group than in the other two groups (p < 0.05, t-test). PSQI values were not significantly different among the three groups. Regression analysis correlated myopic error with poor SHS (p = 0.003), eveningness chronotype (p = 0.032), late wake-up time (p = 0.024), and late bedtime (p = 0.019). Conclusions: University students with myopia tended to be unhappy, have an eveningness chronotype, wake up late, and go to bed late compared to less myopic subjects. Optimal correction might, therefore, be beneficial to myopic students in addition to preventing progression to high myopia in early childhood to potentially avoid related negative effects on mental health and sleep habits in adolescence.

Adolescents' mental health concerns, reported with an idiographic assessment tool

Background

Adolescents’ self-defined concerns about their mental health are understudied. Yet gaining insight into the individual concerns of this group could be helpful in providing better services to the adolescent population. In this study, an idiographic procedure called Assert was used to increase our knowledge of which concerns are reported by adolescents as the most salient, in a primary mental health care situation.

Method

231 unique concerns were reported by 70 adolescents in a primary mental health context in Norway. These concerns were analysed qualitatively by a group of experts, to define categories. The distribution of these categories, and differences in gender and age, were analysed quantitatively. The alleviation experienced on the subjective concerns over the course of counselling was measured. Two linear multilevel models were analysed, to examine whether alleviation on self-defined concerns, as measured with Assert, differed-based on the main category of the concern or the number of times Assert was used.

Results

Three main categories of concerns emerged, related to (1) Self, (2) Relationships and (3) Life domains; as well as nine sub-categories: (1a) Autonomy, (1b) Mental health, (1c) Somatic health, (2a) Improving of relationships, (2b) Feeling safe from people around them, (2c) Taking responsibility for others, (3a) School, (3b) Work and (3c) Spare time. Girls reported fewer Life domain concerns than boys. Younger adolescents (12–16) more frequently reported no Self concerns, and older adolescents (17–23) more frequently reported no Relationship concerns. The adolescents felt less bothered by their subjective concerns after counselling, and there were some differences in alleviation depending on the category of concern.

Conclusions

The adolescents defined their own concerns at the start of counselling and were less troubled by these concerns after counselling. The content of the concerns might suggest that these adolescents experienced a need to improve across several arenas: personal, relational and academic. Research to extend the current study, to understand individual adolescent concerns, should include contextual and social factors and personal characteristics—and explore how counselling interventions can best help alleviate these personal concerns.

Lost in space - an exploration of help-seeking among young people with mental health problems: a constructivist grounded theory study

BACKGROUND

Mental health problems among young people is a worldwide public health concern. There has been an increase in mental health problems among young people in the Nordic countries in the last 25 years, particularly in Sweden. Despite this increase, international research has repeatedly shown that young people do not access or receive support when encountering mental health problems. The purpose of this study was to explore the process of help-seeking for professional support among young people with mental health problems.

METHODS

The study used qualitative constructivist Grounded Theory and open-ended interviews. Thirteen young people between 15 and 23, recruited from two local support clinics, were interviewed.

RESULTS

Lost in space emerged as the core category, capturing aspects of both the experience of self and mental health problems as well as the process of seeking and acquiring help from professional support systems. The study identified several prominent barriers for seeking and acquiring professional help for mental health problems. The young people expressed a lack of knowledge on mental health issues and support services and substantial efforts were made to try to cope with problems on one's own. Lost in space involved Drifting - trying to make sense of own experiences and struggling to cope with problems, Navigating - searching for help through multiple attempts and contacts and Docking - finding support with something/somebody that feels right.

CONCLUSIONS

The theoretical model sheds light on how young people with mental health problems were met with fragmented support services. Society needs to provide encompassing, youth-friendly and flexible support services, so that attempts at help-seeking are not missed.

Registered nurses’ experiences of assessing patients with mental illness in emergency care: A qualitative descriptive study

Patients with mental illness are exposed and experience themselves as not being taken seriously in emergency care. Registered nurses need to assess patients with mental illness from a holistic perspective comprising both a physical and an existential dimension. The aim of the study was to describe registered nurses’ (RNs) experiences of assessing patients with mental illness in emergency care. Twenty-eight RNs in prehospital and in-hospital emergency care were individually interviewed. The interviews were analysed descriptively. The design followed the COREQ-checklist. One main theme ‘A conditional patient assessment’ and two themes; ‘A challenged professional role’ and ‘A limited openness for the patient’, comprising in turn four sub-themes emerged. Although the RNs showed willingness to understand the mental illness aspects of their patients, they were insufficient in their assessments. This implies the importance of developing emergency care RNs’ competence, knowledge and self-confidence in assessments and care of patients with mental illness.

Trends over Time in Adolescent Emotional Wellbeing in the Netherlands, 2005-2017: Links with Perceived Schoolwork Pressure, Parent-Adolescent Communication and Bullying Victimization

In some Scandinavian countries, the United Kingdom and the United States, there is evidence of a dramatic decline in adolescent emotional wellbeing, particularly among girls. It is not clear to what extent this decline can be generalised to other high-income countries. This study examines trends over time (2005-2009-2013-2017) in adolescent wellbeing in the Netherlands, a country where young people have consistently reported one of the highest levels of wellbeing across Europe. It also assesses parallel changes over time in perceived schoolwork pressure, parent-adolescent communication, and bullying victimization. Data were derived from four waves of the nationally representative, cross-sectional Dutch Health Behaviour in School-aged Children study (N = 21,901; 49% girls; M_age = 13.78, SD = 1.25). Trends in emotional wellbeing (i.e., emotional symptoms, psychosomatic complaints, life satisfaction) were assessed by means of multiple regression analyses with survey year as a predictor, controlling for background variables. Emotional wellbeing slightly declined among adolescent boys and girls between 2009 and 2013. A substantial increase in perceived schoolwork pressure was associated with this decline in emotional wellbeing. Improved parent-adolescent communication and a decline in bullying victimization may explain why emotional wellbeing remained stable between 2013 and 2017, in spite of a further increase in schoolwork pressure. Associations between emotional wellbeing on the one hand and perceived schoolwork pressure, parent-adolescent communication, and bullying victimization on the other were stronger for girls than for boys. Overall, although increasing schoolwork pressure may be one of the drivers of declining emotional wellbeing in adolescents, in the Netherlands this negative trend was buffered by increasing support by parents and peers. Cross-national research into this topic is warranted to examine the extent to which these findings can be generalised to other high-income countries.

School-related physical activity interventions and mental health among children: a systematic review and meta-analysis

BACKGROUND

Low levels of physical activity, sedentary behaviour and mental health problems are issues that have received considerable attention in the last decade. The aim of this systematic review and meta-analysis was to investigate effects of interventions targeting school-related physical activity or sedentary behaviour on mental health in children and adolescents and to identify the features of effective interventions.

METHODS

Scientific articles published between January 2009 and October 2019 fulfilling the following criteria were included: general populations of children and adolescents between age 4 and 19, all types of school-related efforts to promote physical activity or reduce sedentary behaviour. Study selection, data extraction and quality assessment were done by at least two authors independently of each other. Data were analysed with a random effects meta-analysis and by narrative moderator analyses.

RESULTS

The literature search resulted in 10265 unique articles. Thirty-one articles, describing 30 interventions, were finally included. Eleven relevant outcomes were identified: health-related quality of life, well-being, self-esteem and self-worth, resilience, positive effect, positive mental health, anxiety, depression, emotional problems, negative effect and internalising mental health problems. There was a significant beneficial effect of school-related physical activity interventions on resilience (Hedges' g = 0.748, 95% CI = 0.326; 1.170, p = 0.001), positive mental health (Hedges' g = 0.405, 95% CI = 0.208; 0.603, p = < 0.001), well-being (Hedges' g = 0.877, 95% CI = 0.356; 1.398, p = < 0.001) and anxiety (Hedges' g = 0.347, 95% CI = 0.072; 0.623, p = 0.013). Heterogeneity was moderate to high (I² = 59-98%) between studies for all outcomes except positive effect, where heterogeneity was low (I² = 2%). The narrative moderator analyses of outcomes based on 10 or more studies showed that age of the children moderated the effect of the intervention on internalising mental health problems. Interventions in younger children showed a significantly negative or no effect on internalising mental health problems while those in older children showed a significant positive or no effect. Moreover, studies with a high implementation reach showed a significant negative or no effect while those with a low level of implementation showed no or a positive effect. No signs of effect moderation were found for self-esteem, well-being or positive mental health. Risk of publication bias was evident for several outcomes, but adjustment did not change the results.

CONCLUSIONS

School-related physical activity interventions may reduce anxiety, increase resilience, improve well-being and increase positive mental health in children and adolescents. Considering the positive effects of physical activity on health in general, these findings may reinforce school-based initiatives to increase physical activity. However, the studies show considerable heterogeneity. The results should therefore be interpreted with caution. Future studies should report on implementation factors and more clearly describe the activities of the control group and whether the activity is added to or replacing ordinary physical education lessons in order to aid interpretation of results.

TRIAL REGISTRATION

PROSPERO, CRD42018086757.

Clusters of Contemporary Risk and Their Relationship to Mental Well-Being Among 15-Year-Old Adolescents Across 37 Countries

PURPOSE

Adolescents' mental well-being has become a growing public health concern. Adolescents' daily lives and their engagement in risks have changed dramatically in the course of the 21st century, leading to a need to update traditional models of risk to include new exposures and behaviors. To date, studies have examined the relationship between (mainly traditional) risk behaviors and adolescent mental well-being or looked at risk factors that jeopardize mental well-being such as lack of social support but have not combined them together to highlight the most significant risks for adolescent mental well-being today. The present study included new and traditional risk behaviors and risk factors, robustly derived an empirically based model of clusters of risk, and examined the relative association of these clusters to adolescent mental well-being.

METHODS

Data from the 2017-2018 Health Behaviours in School-aged Children study were used. The sample included 32,884 adolescents (51.7% girls) aged 15 years from 37 countries and regions. The principal component analysis was used to determine the existence of clusters of risk, using 21 items related to adolescent mental well-being that included both risk behaviors (e.g., substance use) and risk factors (e.g., peer support). Analysis was conducted in both a randomly split training and test set and in gender separate models. Mixed-effects logistic regressions examined the association between clusters of risk and mental well-being indices (low life satisfaction and psychosomatic complaints).

RESULTS

Seven clusters of risk were identified: substance use and early sex, low social support, insufficient nutrition, bullying, sugary foods and drinks, physical health risk, and problematic social media use (SMU). Low social support and SMU were the strongest predictors of low life satisfaction (odds ratios = 2.167 and 1.330, respectively) and psychosomatic complaints (odds ratio = 1.687 and 1.386, respectively). Few gender differences in predictors were found. Exposure to bullying was somewhat more associated with psychosomatic complaints for girls, whereas physical health risk was associated with reduced relative odds of low life satisfaction among boys. Split-sample validation and out-of-sample prediction confirmed the robustness of the results.

CONCLUSIONS

The results highlight the importance of contemporary clusters of risk, such as low social support and SMU in the mental well-being of young people and the need to focus on these as targets for prevention. We propose that future studies should use composite risk measures that take into account both risk behaviors and risk factors to explain adolescents' mental well-being.

Cross-National Time Trends in Adolescent Mental Well-Being From 2002 to 2018 and the Explanatory Role of Schoolwork Pressure

PURPOSE

Previous research has shown inconsistent time trends in adolescent mental well-being, but potential underlying mechanisms for such trends are yet to be examined. This study investigates cross-national time trends in adolescent mental well-being (psychosomatic health complaints and life satisfaction) in mainly European countries and the extent to which time trends in schoolwork pressure explain these trends.

METHODS

Data from 915,054 adolescents from 36 countries (50.8% girls; mean_age = 13.54; standard deviation_age = 1.63) across five Health Behaviour in School-aged Children surveys (2002, 2006, 2010, 2014, and 2018) were included in the analyses. Hierarchical multilevel models estimated cross-national trends in adolescent mental well-being and schoolwork pressure. We also tested whether schoolwork pressure could explain these trends in mental well-being.

RESULTS

A small linear increase over time in psychosomatic complaints and schoolwork pressure was found. No change in life satisfaction emerged. Furthermore, there was large cross-country variation in the prevalence of, and trends over time in, adolescent mental well-being and schoolwork pressure. Overall, declines in well-being and increases in schoolwork pressure were apparent in the higher income countries. Across countries, the small increase in schoolwork pressure over time partly explained the decline in psychosomatic health complaints.

CONCLUSIONS

Our findings do not provide evidence for substantial declines in mental well-being among adolescents. Yet, the small declines in mental well-being and increases in schoolwork pressure appear to be quite consistent across high-income countries. This calls for the attention of public health professionals and policy-makers. Country differences in trends in both adolescent mental well-being outcomes and schoolwork pressure were considerable, which requires caution regarding the cross-national generalization of national trends.

Gender and secular trends in adolescent mental health over 24 years - The role of school-related stress

Increasing levels of psychosomatic symptoms, and other mental health problems, among adolescents, and especially among girls, have been reported across various countries. The "educational stressors hypothesis" states that this trend can be explained by an increasing amount of stressors in the school environment. This study tests this hypothesis, using repeated cross-sectional data, between the years 1993-2017, from the Health Behaviours of School-aged Children (HBSC) survey. Regression and decomposition techniques are used to investigate the role of school stress for trends in psychosomatic symptoms, and for gender differences in symptoms. Results show that the effects of school stress on psychosomatic symptoms have become stronger over time, but that they can only account for a small share of the overall increase in symptoms since 1993. However, school stress has increased more among girls than among boys, and it explains about half of the growth of the gender gap in symptoms. Thus, school stress accounts for a substantial portion of the increase in symptoms for girls, but only a minor share of the increase for boys. In sum, we found weak evidence for the educational stressors hypothesis in regard to the overall trend in symptoms, but strong evidence for it in explaining the growing gender gap.

The association between early life mental health and alcohol use behaviours in adulthood: A systematic review

This systematic review aims to summarise current evidence on the association between early life mental health and alcohol use behaviours in adulthood. Peer-reviewed publications were located by searching EMBASE, Medline, PsycINFO, and the ISI Web of Science up to 31 October 2018. Prospective longitudinal studies reporting associations between externalising problems (EXT), internalising problems (INT), depression, anxiety before age 18, and alcohol use behaviours (alcohol consumption, heavy/problematic drinking, alcohol use disorder) after age 18 were included. After screening 17259 articles, 36 articles met the inclusion criteria. Information extracted included strength of associations, age when mental health and alcohol use behaviours were measured, sex differences in the association, and other sample characteristics. 103 tests in 23 articles were identified on the externalising domain and 135 tests in 26 articles on the internalising domain. 37 out of 103 tests reported positive associations between EXT and alcohol use behaviours. The likelihood of observing positive associations was higher for more severe alcohol use outcomes, but this trend disappeared among high-quality studies. Findings on associations between internalising domain and alcohol use varied across their subtypes. INT tended to be negatively associated with alcohol consumption but positively associated with more severe outcomes (heavy/problematic drinking, alcohol use disorder). Depression tended to be positively associated with alcohol outcomes, while no clear association between anxiety and alcohol outcomes was evident. Variation of the association across developmental timing, sex, culture, historical period was explored where appropriate. Great heterogeneity in the current literature calls for greater attention to view the relationship developmentally.

Negative emotional states and negative life events: Consequences for cardiovascular health in a general population

OBJECTIVE

The contemporary increase in psychological distress observed in many countries is, by itself, a public health issue of great concern. The present study aims to investigate associations between self-reported negative emotional states and negative life events, and cardiovascular disease (CVD).

METHODS

Prospective cohort study based on the Swedish INTERGENE cohort comprising 3614 men and women, aged 25 to 75. Baseline examinations during 2001-2004 included self-rating depression and anxiety scales, life stress, as well as a wide range of physiological and behavioral parameters, which allowed for relevant adjustments. Cox proportion hazard was used to predict incident CVD, CVD mortality as well as all-cause mortality.

RESULTS

The results showed a dose-response relationship between depressiveness, anxiety and negative life events on the one hand, and increased risk of CVD. Most of these associations persisted in the fully adjusted models. Furthermore, the youngest age group (25-44 years) generally showed the highest prevalence of psychosocial distress, and also had the highest risks of incident CVD with regard to depression and anxiety.

CONCLUSION

The associations between psychological distress and later life cardiovascular disease calls for enhanced public health efforts aiming at ameliorating psychological health, not least in younger age groups.

Increase of internalized mental health symptoms among adolescents during the last three decades

Background

Previous studies suggest an overall increase of adolescent mental health symptoms globally since the 1980s until today, especially an increase of internalizing symptoms in girls. Due to methodological limitations of these studies, further studies are warranted to obtain a more solid knowledgebase.

Methods

This study was cross-sectional and compared two separate but geographically identical groups of adolescents in a middle-sized industrial municipality in Northern Sweden at two time-points [(i) 1981, n = 1083, (505 girls, 577 boys), response rate 99.7%; (ii) 2014, n = 682, (338 girls, 344 boys), response rate 98.3%]. All students in their last year of compulsory school were included. The same self-report questionnaire, consisting of four sub-scales (functional somatic-, anxiety-, depressive symptoms and conduct problems), was used at both occasions. Data were analyzed with descriptive statistics, two-way ANOVA and general linear model.

Results

Symptoms of anxiety and depression and functional somatic symptoms, increased among both boys and girls from 1981 until 2014 (P < 0.001 for all subscales), and the increase of these symptoms was higher in girls. Conduct problems were significantly higher in boys in 1981 and decreased over time so that in 2014 there was no longer a significant difference between boys and girls regarding conduct problems (P = 0.286).

Conclusion

In this population-based study spanning over 30 years, both girls and boys showed increasing internalizing problems, while conduct problems decreased. To halt this trend, we need a deeper understanding of the impact of the major societal changes that have occurred during the last three decades.

Self-perception of physical activity and fitness is related to lower psychosomatic health symptoms in adolescents with unhealthy lifestyles

The general aim of the present study was to examine how physical activity, participation in sports, and beliefs about personal physical activity and physical fitness are associated with adolescents' psychosomatic health complaints (PHC) in relation to their lifestyles.

METHODS

A total of 3284 11-19-year-old adolescents (average age 14.9 ± 2.0; 48.6% male) participated in the population-based cross-sectional study. Self-administered questionnaires addressed lifestyle, sports participation, physical activity, physical fitness perception, and PHC.

RESULTS

Female gender (OR = 1.92; 95% CI = 1.57-2.35), smoking (OR = 1.31; 95%PI = 1.01-1.68), alcohol consumption (OR = 1.60; 95%PI = 1.30-1.97), unhealthy foods (OR = 1.14; 95%PI = 1.04-1.26), hours of internet use (OR = 1.14; 95%PI = 1.07-1.21), and poor personal fitness perception (OR = 1.60; 95% CI = 1.27-2.02) were associated with PHC in adolescents. Lower physical activity and self-perceived insufficient physical activity, perception of physical fitness as being poor, and not participating in sports were associated with greater somatic and psychological complaints controlling for age, gender, and BMI. Participation in sports and physical activity did not change PHC in adolescents involved in unhealthy behaviour. However, a positive perception of one's own physical activity and physical fitness decreased PHC in adolescents who reported an unhealthy lifestyle.

CONCLUSIONS

Adolescents demonstrating poorer health-related behavioural profiles showed higher PHC. Physical activity and sports participation were related to lower PHC. Positive physical activity and physical fitness perception changed the associations between PHC and unhealthy lifestyle: adolescents perceiving themselves as sufficiently physically active and those evaluating their physical fitness as good showed lower PHC, despite the presence of unhealthy habits (high screen time, drinking alcohol, smoking, and consuming unhealthy foods). It is important to study cognitive factors when exploring the associations between adolescent lifestyles and PHC. These results are important for health promotion and education programmes aimed at improving healthy lifestyle and psychosocial well-being in adolescents.

To know or not to know? Mentalization as protection from somatic complaints

Somatization processes are usually associated with a lack of insight or with emotional unawareness, especially in adolescents where the ability for self-reflection is beginning to mature. However, the extent to which different levels of insight explain variations in somatization remains understudied. This study aimed to evaluate whether high-level emotional awareness (comprehension) but not low-level awareness (only attention) is needed to psychologically cope with suffering, thus leading to lower somatization. Specific predictions were: 1) High attention along with High comprehension will be associated with significantly lower frequency of somatic complaints than other combinations (Low attention and Low comprehension, or High attention but Low comprehension); 2) In absence of comprehension, no attention will be more optimal than attention only, because only-attention might work as an amplificatory of suffering without the possibility of processing it. Self-reports of meta-cognitive processes, somatization, and control variables were obtained from 264 adolescents from a non-clinical population (54.5% female; aged 12-18, M = 14.7, SD = 1.7). In line with expectations, results revealed significant differences in the effects of insight positions on somatization: Attention+Comprehension (M = 4.9, SE = 0.9) < Nothing (M = 7.1, SE = 0.3) < Only attention (M = 8.9, SE = 0.7). Compared to Nothing, Attention+comprehension was associated with significantly reduced somatic complaints (B = -2.2, p = 0.03, 95% CI -4,1 to 0.2). However, Only attention was associated with increased somatic complaints compared to the other two conditions (B = 1.8, p = 0.03, 95% CI 0.2 to 3.4; B = 4, CI 95% 1.6-6.3, p = 0.001, respectively). This highlights the role of higher-order awareness (i.e., comprehension or clarity) in the processing of suffering and stresses its value in the adaptive coping of emotional distress.

Cross-country comparisons of trends in adolescent psychosomatic symptoms - a Rasch analysis of HBSC data from four Nordic countries

BACKGROUND

To analyse the psychometric properties of the HBSC Symptom Checklist (HBSC-SCL) on psychosomatic symptoms with a focus on the operating characteristics of the items, and on the impacts of measurement distortions on the comparisons of person measures across time and between countries.

METHODS

Data were collected in 1993/94, 1997/98, 2001/02, 2005/06, 2008/09, 2013/14 in Denmark, Finland, Norway and Sweden as part of the Health Behaviour in School-aged Children (HBSC) study. Data comprised 116,531 students 11, 13 and 15 years old. Rasch analysis was conducted of the HBSC-SCL consisting of eight items with a focus on Differential Item Functioning (DIF) and item threshold ordering. The impacts of DIF and threshold disordering on trend analyses were analysed in a subsample consisting of 15 years old students.

RESULTS

One item shows evidence of severe DIF and the categorisation of some items does not seem to work as intended. Analyses of changes based on proportions of psychosomatic symptoms show that bad item functioning affects some comparisons between countries across time: A four percentage point difference between 15 years old girls in Finland and Sweden concerning the rate of increase of psychosomatic symptoms from 1994 to 2014 disappears when the problems with DIF and disordered item thresholds are taken into account. Although the proportions of students with psychosomatic symptoms are clearly higher 2014 than 1994 in all four countries the shape of most trends is nonlinear.

CONCLUSIONS

Some of the cross-country comparisons were distorted because of DIF and problems related to disordering of the item thresholds. The comparisons among girls between Finland and Sweden were affected by the problems pertaining to the original measure of psychosomatic symptoms, while the trend patterns among boys were not much affected. In addition to confirming increasing rates of adolescent mental health problems in the Nordic countries, the substantive analyses in the current study show that Finland is joining Sweden in having the sharpest increase among older adolescents, in particular among girls. To improve the functioning of the scale the DIF item could be removed or replaced and response categories collapsed in post hoc analyses.

Health complaints among adolescents in Norway: A twenty-year perspective on trends

Purpose

Examine time trends in health complaints among adolescents in Norway between 1994 and 2014 and among population subgroups, e.g., age and gender, as well as their interactions.

Methods

Norwegian data on 11-16-year-olds were drawn from the Health Behaviour in School-aged Children survey (HBSC) and analyzed for 1994 (n = 4,952), 1998 (n = 5,026), 2002 (n = 5,023), 2006 (n = 4,711), 2010 (n = 4,342) and 2014 (n = 3,422). Design adjusted linear regression that accounts for clustering effects was used to examine mean scores of two subscales of the HBSC-symptom checklist: psychological and somatic health complaints.

Results

Psychological and somatic health complaints among adolescents in Norway followed somewhat different trajectories, but the mean scores of both types of health complaints appeared to increase during the 20-year period. For psychological health complaints, there was a three-way interaction between age, gender and time, indicating that increasing trends in health complaints depended on both age and gender, in which older adolescent girls had a greater increase over time relative to younger adolescents and boys.

Conclusions

Findings from this study, together with earlier findings, suggest that there has been an increasing trend in health complaints among adolescents in Norway from 1994 to 2014, especially among older adolescent girls. Future research should examine if trends in health complaints also depend on gender and age in other contexts. This will help the planning and implementation of tailored and effective interventions.

What Predicts Stable Mental Health in the 18⁻29 Age Group Compared to Older Age Groups? Results from the Stockholm Public Health Cohort 2002⁻2014

Mental health has decreased in young people since the 1990s, and mental health promotion is an urgent matter. A first step is to identify which social determinants could be of importance for intervention. We used the Stockholm Public Health Cohort, a longitudinal population-based health survey, completed by 31,000 inhabitants in the Stockholm County. We focused on the 18⁻29 age group, n = 3373 (60% females, 40% males) and aimed at assessing which social determinants predict stable mental health, measured as scoring <3 points on the General Health Questionnaire 12 at all time points: 2002, 2007, 2010, and 2014. Forty-six percent of males and 36% of females reported stable mental health. Among the 17 predictors on sociodemographics, socioeconomics, social capital, health behavior, and victimization, six predicted stable mental health in the following order: occupation and especially employment, emotional support, male gender, being born in Sweden, absence of financial strain, and consumption of fruit and berries. In the 30⁻84 age group, 66% males and 55% females reported stable mental health. Nine determinants in the following rank predicted stable mental health: absence of financial strain, occupation and especially being self-employed, emotional support, male gender, physical activity, instrumental support, interpersonal trust, community trust, and absence of hazardous alcohol consumption. Interaction analysis showed significant difference between the younger and older group regarding physical activity and absence of financial strain with importance being higher for the older group. Our findings indicate that the determinants of health differ across the life-course with fewer predictors related to social capital and health behavior in the younger group compared to the older. We conclude that health-promoting interventions should be lifespan-sensitive.