School burnout and schoolwork engagement profiles among French high school students: Associations with perceived academic stress and social support

Adolescents' well-being at school is positively affected by social support from parents, teachers, and peers and negatively affected by academic stress. However, little is known about how specific academic stressors are related to study-related well-being profiles. This study used a person-centered approach to identify the profiles of high school students based on their school burnout (i.e., exhaustion and cynicism) and engagement levels to examine their associated levels of perceived academic stress, social support, and sociodemographic characteristics. Using cluster analysis on a sample of 540 high school students (67.8% girls), we identified five profiles labeled "Engaged" (22.4%), "Relaxed" (18.9%), "Overextended" (25.6%), "Disengaged" (17.6%), and "Burned out" (15.4%). The "Engaged" and "Relaxed" groups experienced similar levels of perceived social support, but the "Engaged" students showed higher academic stress levels. The "Overextended" group displayed high academic stress with lower social support, while the "Disengaged" group showed low stress with low social support. Finally, the "Burned out" group displayed the highest academic stress and the lowest perceived support. Results are discussed within the demands-resources model of school burnout and clinical implications are presented for each profile.

The moderating role of psychological capital in the relationship between school-related stress and outcomes of academic achievement and behavior problems among students with health impairments

Numerous researches have examined the relationship between school-related stress and outcomes of academic achievement and behavior problems; however, a very few studies were conducted to assess the moderating role of psychological capital in this relat.ionship, especially focusing on students with health impairments. The current study was carried out to investigate the association of school-related stress and psychological capital with academic achievement and behavior problems in students with health impairments, as well as the possible moderating influence of psychological capital in the school-related stress and outcomes relationships. The study involved 233 students with health impairments in Addis Ababa. Instruments used for the study include the Demographic Questionnaire, Perceived School-Related Stress Scale, Psychological Capital Questionnaire, Strengths and Difficulties Questionnaire, and school record reviews. Descriptive statistics, structural equation modeling, and multi-group structural equation modeling were utilized to analyze the data. Results revealed that school-related stress was significantly and negatively associated with academic achievement and positively with behavior problems. Psychological capital was significantly and positively associated with academic achievement and negatively with behavior problems. Higher levels of psychological capital had a significant moderating role in the relationships between school-related stress and both outcomes of academic achievement and behavior problems. The finding suggests that PsyCap is a positive resource to counteract the detrimental impacts of school-related stress on the academic achievement and behavior problems of students with health impairments.

School-aged children's movement behaviours and subjective health complaints in Japan: a cross-sectional study during COVID-19 pandemic-related school closures and after school reopenings

BACKGROUND

Social restrictions associated with the COVID-19 pandemic have altered children's movement behaviours and impacted their mental health. However, the influence of social restrictions on subjective health complaints remains inadequately understood. This study compared adherence to 24-hour movement behaviour guidelines and the prevalence of subjective health complaints during school closure and one year after reopening. We also examined how combinations of adherence to movement behaviour recommendations relate to subjective health complaints.

METHODS

A repeated cross-sectional survey was conducted at two points. The first survey in May 2020 included 1535 (766 boys and 769 girls) participants during school closures, while the second survey from May to July 2021 involved 1125 (583 boys and 542 girls) participants one year after school reopening. The questionnaire covered socio-demographics, physical activity, screen time, sleep, and subjective health complaints. Differences between periods were analysed using chi-square tests. Logistic regression models assessed the association between adherence to guidelines and subjective health complaints.

RESULTS

During school closure, children were more likely to meet 'only sleep' recommendations and have irritability and lethargy symptoms. Irrespective of sex, those adhering to two or all three recommendations (excluding physical activity and screen time) had a lower risk of symptoms related to physical and mental pain, fatigue, irritability, and lethargy as compared to those who met none of the recommendations.

CONCLUSIONS

Children should meet at least one physical activity or screen time recommendation in addition to sleep recommendations for subjective health. Strategies considering the priority of each movement behaviour are crucial, even during abnormal situations, such as pandemic-related social restrictions. This study offers insightful findings concerning children's mental health issues during unprecedented and massive disasters or crises.

Effect of a Physical Education Teacher's Autonomy Support on Self-Esteem in Secondary-School Students: The Mediating Role of Emotional Intelligence

The purpose of this study was to analyse the effect of emotional intelligence between the perception of autonomy support from physical education teachers and self-esteem (positive and negative) in secondary-school physical education students. The study design was observational, descriptive, and cross-sectional. In total, 1069 secondary-school physical education students participated (Mage = 14.55; SD = 1.54) (51.2% female; 48.8% male). The following scales were used: The Learning Climate Questionnaire adapted to Physical Education (i.e., autonomy support), the Trait Meta-Mood Scale-24 (i.e., emotional attention, emotional clarity, and emotional repair), and the Rosenberg Self-Esteem Scale (positive self-esteem, negative self-esteem). A structural equation model was performed with the latent variables controlled by age, sex, and the students' educational centre. The main results indicate that the explained variance was 37% for positive self-esteem and 26% for negative self-esteem. In addition, autonomy support directly predicts emotional intelligence (p < 0.05) and positive self-esteem (p < 0.001). On the other hand, all indirect effects of autonomy support on self-esteem across emotional intelligence were significant at p < 0.001. Finally, emotional clarity and emotional repair had a mediating effect on self-esteem, and it improves the total effect of autonomy support on positive self-esteem with values of β = 0.14 and β = 0.19, respectively, and a value of β = -0.07 and β = -0.06 for negative self-esteem. The findings reveal the necessity to improve emotional clarity and emotional repair in secondary-school students in improving positive self-esteem through the perception of autonomy support from the physical education teacher.

Stress and Anxiety among High School Adolescents: Correlations between Physiological and Psychological Indicators in a Longitudinal Follow-Up Study

Mental and psychological disorders are serious health problems worldwide. Anxiety among high school students can affect school performance, relationships, and family life.

OBJECTIVE

Our aim is to understand the anxiety levels and associated factors among high school students and compare the results of psychological tests measuring anxiety with the cortisol levels obtained from biological sampling.

METHOD

In our longitudinal follow-up study, we involved 125 individuals in May 2019. Validated measurement tools were used during questionnaire data collection, including the State-Trait Anxiety Inventory, Clear Communication Scale, Multiple Social Perceived Support Scale, and related HBSC questions. As objective data, we collected hair samples for cortisol level measurement.

RESULTS

At the end of the school year, the anxiety levels measured by psychological tests were significantly higher (p = 0.001) compared to the anxiety levels at the beginning of the next school year. Anxiety levels were higher among girls and were influenced by the type of school and parental expectations. Both state anxiety and trait anxiety showed a strong correlation with psychosomatic symptoms (p < 0.001) and anxiety arising from school expectations (p < 0.05). The changes in cortisol levels did not follow the changes in psychological tests. Cortisol level increased (p = 0.01) in the second sample.

A systematic review of longitudinal changes in school burnout among adolescents: Trajectories, predictors, and outcomes

INTRODUCTION

School burnout (SBO) is a public health issue with possible long-term consequences that occurs among developing adolescents. To design prevention policies, SBO's causes and consequences must be established. Moreover, a better understanding of its development might help identify key moments for interventions. Longitudinal studies can reveal whether SBO changes or remains stable over time and can track how its different dimensions develop. They can also clarify the distinction between the predictors and outcomes of SBO.

METHODS

This systematic review follows PRISMA guidelines and aims to synthesize knowledge about the development of SBO and its predictors and outcomes. We queried databases for articles published between January 2002 and February 2021 that use a quantitative assessment of SBO and have longitudinal designs using students in secondary education.

RESULTS

Forty-three articles representing 48 studies were included in this review. The most-documented risk factors are female gender and high school academic track. Exhaustion is the first dimension of SBO to develop. The most-documented risk factors are female gender and high school academic track. Relationships with parents serve as a protective factor. Outcomes of SBO include lower engagement at school, impaired identity development, and lower satisfaction with life. Complex relationships are found between SBO, problematic use of internet, problematic use of social media, and depressive symptoms. The three are likely to be caused by SBO but probably develop in vicious cycles.

CONCLUSION

More research on the organizational factors influencing SBO in diverse educational systems is needed.

Clinical Presentations of Teenage Outpatients Encountered by General Internists in Japanese Hospitals: A Cross-Sectional Study

Introduction General internists in Japanese hospitals sometimes consult on adolescents. Our university hospital encounters more adolescents with mental health complaints than other city hospitals. Consequently, based on our experience, we hypothesized that psychiatric disorders are significantly more common among teenagers who visit general internists. Therefore, we retrospectively analyzed the clinical profiles of teenage outpatients who visited general internists at three hospitals to test this hypothesis. Methods This study included 342 patients aged 13-19 years who visited the Departments of General Internal Medicine at Toyama University Hospital, Nanto Municipal Hospital, and Kamicichi General Hospital between January 2019 and December 2021. Data on age, sex, chief complaint, the period from onset to visit, referral status, and final diagnosis were collected from medical records. We also identified the final diagnoses of 1,375 outpatients from the university hospital during the same period, stratifying them by age. Multiple comparison analyses, Chi-squared tests, and residual analyses were performed to analyze the data. Results The number of psychiatric teen patients was significantly higher in the university hospital group than in the other city hospital groups (p<0.01). The incidence of psychiatric disorders, such as stress-related mental disorders, including adjustment and eating disorders (p<0.001), was also significantly higher in the teenage group (13-19 years) than in other age groups. Most psychiatric disorders lead to complaints of physical symptoms. Conclusions The potential onset of clinical episodes during consultations with teenage patients can make treating this age group more challenging; thus, they may require care at university hospitals. Furthermore, Japanese general internists in university hospitals encounter patients in their late teens with physical signs more often than in other hospitals. This trend may be unique to general medicine departments ("Sogo-Shinryo") in Japanese university hospitals. However, if general internists act under primary care principles, they can adequately assist adolescent patients.

Examining Predictors of Psychological Well-Being among University Students: A Descriptive Comparative Study across Thailand and Singapore

BACKGROUND

Psychological well-being (PWB) is a significant indicator of positive psychology. Thus far, the predictors of PWB are not well-understood among university students in Asian countries.

PURPOSE

This study aimed to investigate the relationships between PWB and its predictors (stress, resilience, mindfulness, self-efficacy, and social support) in Thai and Singaporean undergraduates. Stress is perceived to have a negative influence on PWB, but mindfulness, resilience, self-efficacy, and social support indicate positive influences.

METHODS

A cross-sectional descriptive predictive research design was used with 966 Thai and 696 Singaporean university students. After calculating an adequate sample size and performing convenience sampling, we administered the following six standard scales: the Perceived Stress Scale, the Connor-Davidson Resilience Scale, the Mindfulness Awareness Scale, the General Self-Efficacy Scale, the Multi-dimensional Scale of Perceived Social Support, and the Psychological Well-being Scale, along with a demographic questionnaire. Descriptive statistics, correlation analysis, and structural equation modeling were performed for participants' PWB.

RESULTS

Mindfulness had significant effects on both factors of PWB, including autonomy and growth, and cognitive triad, across two samples. In the Thai sample, resilience most strongly predicted autonomy and growth and perceived stress did so the cognitive triad, whereas in the Singaporean sample, perceived control most strongly predicted autonomy and growth and support from friends did so the cognitive triad.

CONCLUSION

These findings provide specific knowledge towards enhancing psychosocial interventions and promoting PWB to strengthen mindfulness, resilience, perceived control of stress, and social support.

Preventing Stress among High School Students in Denmark through the Multicomponent Healthy High School Intervention-The Effectiveness at First Follow-Up

Stress is a widespread phenomenon and young people especially are experiencing high levels of stress. School-related factors are the most frequently self-reported stressors among adolescents, but few interventions have targeted the school environment. This study evaluated the effectiveness of the Healthy High School (HHS) intervention on stress at a 9-month follow-up. The study included 5201 first-year high school students (~16 years) in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (N = 15). Baseline measurements were conducted in August 2016 and the follow-up was conducted in May 2017. The intervention was designed to promote well-being (primary outcome) by focusing on physical activity, meals, sleep, sense of security, and stress (secondary outcomes). The intervention comprised: structural initiatives at the school level; a teaching material; peer-led innovation workshops; and a smartphone app. The 10-item Perceived Stress Scale was used to measure stress. Intervention effects on perceived stress were estimated using an intention-to-treat approach with multiple imputations of missing data and multilevel general linear regression modelling. A total of 4577 students answered the baseline questionnaire. No statistically significant difference was found in stress between students at intervention and control schools at the follow-up (mean score: 16.7 versus 16.7, adjusted b = 0.42, 95% CI: -0.16;1.00). The HHS Study is one of the first large randomized controlled trials targeting school environmental stressors. Potential implementation failures and the failures of the program theory are discussed.

The association between exposure to community violence and somatic symptoms through bullying victimization among African American adolescents in Chicago: A developmental trauma approach

BACKGROUND

The developmental trauma theory suggests that traumatic events impede the ability of individuals to form interpersonal relationships, impair cognition, affect, and increase the vulnerability of adolescents to develop psychopathology. However, few studies have examined the applicability of this theory among African American adolescents who were exposed to community violence and adverse outcomes, including bullying victimization and somatic symptoms.

AIMS

Therefore, the purpose of the present study is to first test the association between exposure to community violence and somatic symptoms. Then, we explored whether bullying victimization mediated the relationship between exposure to community violence and somatic symptoms while controlling for gender differences and substance use (n = 622).

RESULTS

Results suggest that exposure to community violence is positively associated with somatic symptoms. Moreover, the association between exposure to community violence and somatic symptoms was mediated by bullying victimization.

DISCUSSION AND CONCLUSION

These results were consistent with the developmental trauma theory, such that trauma could increase the vulnerability for future victimization, thus, leading to somatic symptoms. Implications for research and practice are discussed.

Psychosocial School Conditions and Mental Wellbeing Among Mid-adolescents: Findings From the 2017/18 Swedish HBSC Study

Objectives: To investigate mid-adolescent boys' and girls' experiences of school demands, teacher support, and classmate support, and explore the associations of these factors with mental wellbeing. Methods: Data were derived from the Swedish Health Behaviour in School-aged Children (HBSC) study of 2017/18, with information collected among 1,418 students in grade 9 (∼15-16 years). School demands, teacher support, and classmate support were measured by indices based on three items each. Mental wellbeing was measured by the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Linear regression analyses were performed. Results: Higher demands were associated with lower mental wellbeing. Conversely, mental wellbeing increased with greater teacher support and classmate support. Interactions between demands and the support variables showed that at the lowest levels of teacher and of classmate support, mental wellbeing was low and not associated with school demands. With increasing levels of teacher and classmate support, the overall level of mental wellbeing increased and revealed an inverse association between school demands and mental wellbeing. Conclusion: The study contributes with knowledge about how psychosocial conditions in school may hinder or enhance wellbeing among students.

Gonadal and adrenal hormones interact with pubertal maturation to predict depressive symptoms in a group of high-school females

Adolescent females are at elevated risk for the development of depression. In this study, we addressed two questions: Are pubertal hormones associated with adolescent mental health? Might this association depend on pubertal development? We tested the hypothesis that estradiol, which has been associated with adolescent social sensitivity, might interact with pubertal stage to predict depression risk at three time points in ninth and tenth grade. Hormones and pubertal development were measured ninth-grade females. Linear regression analyses were used to predict fall ninth-grade (N = 79), spring ninth-grade (N = 76), and spring tenth-grade (N = 67) Children's Depression Inventory (CDI) scores. The hypothesized model was not statistically significant, but exploratory analyses revealed that two- and three-way interactions incorporating estradiol, puberty (stage and perceived onset), and cortisol predicted current and future CDI scores. Our exploratory model did not predict changes in CDI but did account for future (spring of ninth grade) CDI scores. Specifically, estradiol was positively correlated with fall and spring ninth-grade depressive symptoms in participants with high cortisol who also reported earlier stages and later perceived onset of pubertal development. These findings suggest that hormones associated with sensitivity to the social environment deserve consideration in models of adolescent depression risk.

Self-Reported Psychosomatic Complaints and Conduct Problems in Swedish Adolescents

Physical conditions in children and adolescents are often under reported during mainstream school years and may underlie mental health disorders. Additionally, comparisons between younger and older schoolchildren may shed light on developmental differences regarding the way in which physical conditions translate into conduct problems. The aim of the current study was to examine the incidence of psychosomatic complaints (PSC) in young and older adolescent boys and girls who also report conduct problems. A total of 3132 Swedish adolescents (age range 15-18 years, 47% boys) completed the Uppsala Life and Health Cross-Sectional Survey (LHS) at school. The LHS question scores were categorised by two researchers who independently identified questions that aligned with DSM-5 conduct disorder (CD) criteria and PSC. MANOVA assessed the effects of PSC, age, and gender on scores that aligned with the DSM criteria for CD. The main effects of gender, age, and PSC on the conduct problem scores were observed. Adolescents with higher PSC scores had higher conduct problem scores. Boys had higher serious violation of rules scores than girls, particularly older boys with higher PSC scores. Psychosomatic complaints could be a useful objective identifier for children and adolescents at risk of developing conduct disorders. This may be especially relevant when a reliance on a child's self-reporting of their behavior may not help to prevent a long-term disturbance to their quality of life.

Burnout and Maladjustment Among Employed Students

Stress and burnout are present in every aspect of an individual's life, and the growing number of employed students raises certain concerns about their engagement in academic tasks and finishing their studies. Our study aims to analyze the differences between student burnout in different contexts, work- and academic-related burnout, and examine the predictive role of burnout in academic maladjustment, including test anxiety as a mediator and occupational status as a moderator. The sample consisted of 151 students from different universities in Romania. Consistent with previous studies, the results showed that academic burnout is higher than work-related burnout. High levels of test anxiety explain high levels of academic burnout, which in turn explains low levels of academic adjustment. The results highlight the mediating role of anxiety in the relationship between academic burnout and academic maladjustment with occupational status as a moderator. Future research should focus on the type of students' job, the mediating relationship between self-efficacy and academic burnout, and the relationship between burnout and personality traits.

Improvement in parasympathetic regulation is associated with engagement in classroom activity in primary school children experiencing poor classroom climate

BACKGROUND

Self-regulation promotes engagement within the classroom. At a physiological level, a good indicator of the ability of the system to self-regulate is cardiac vagal tone (CVT).

AIMS

The present study aims to assess children's change over time (1 year) in their parasympathetic regulation (by way of CVT) in response to a social and cognitive stressor. Moreover, it addresses whether, if present, this change over time in regulation influences students' engagement in classroom activities while also accounting for classroom climate.

SAMPLE

Forty-nine second graders were assessed at two time points: November 2018 (T1) and 1 year later in 2019 (T2).

METHODS

Children's CVT was registered at rest and while performing a stressful task during which they were asked to cognitively perform while being socially evaluated. Children were also interviewed on how much they feel engaged in classroom activities and their perceptions of classroom climate.

RESULTS

A repeated measures analysis of variance including 2 Time Points ×2 Phases of CVT Registration (baseline and during the stressful task) revealed a significant decrease in cardiac vagal activity from baseline to the task at T1, indicating that initially most children were not able to self-regulate and gave way to a stress response when facing the stressful task. The pattern changed at T2 when an active regulation took place signalled by an increase in CVT from baseline to the stressful task. Data analysis also revealed that among children who perceived a poorer classroom climate, the display of greater parasympathetic regulation over time was linked with higher active engagement in classroom activities.

CONCLUSIONS

Growth in physiological regulation in response to a challenging task is associated with better engagement in classroom activities. Interventions and educational practice promoting the development of self-regulation strategies are recommended.

Respiration rate during a stress task moderates neuroticism and perceived stress in older adults

BACKGROUND

Research suggests that respiration rate is related to psychological factors such as neuroticism and perceived stress in addition to physiological factors. However, it is unclear how respiration rate during a laboratory stress task relates to the relationship between neuroticism and perceived stress.

PARTICIPANTS AND PROCEDURE

This cross-sectional secondary analysis examined respiration rate during a stress task in moderating the relationship between neuroticism and perceived stress in a sample of generally healthy older adults (n = 64). Respiration data were collected during an auditory oddball paradigm and the Portland Arithmetic Stress Task (PAST), a laboratory-based cognitive stressor.

RESULTS

The results indicated that respiration rate during the PAST significantly moderated the relationship between neuroticism and perceived stress (p = .031), such that participants who exhibited a very low (-1.78 SD) respiration rate showed a non-significant relationship between neuroticism and perceived stress, whereas participants with average (mean; p < .001) and elevated respiration rates (+1 SD; p < .001) exhibited a significant positive relationship between neuroticism and perceived stress.

CONCLUSIONS

These findings add to a body of literature suggesting that stress reactivity is an important link between personality factors and negative outcomes. However, this is the first study to our knowledge to examine the role of physiological stress reactivity in buffering this relationship. The results suggest that individuals higher in neuroticism may attenuate the relationship between stress vulnerability and perceived stress through decreased physiological stress reactivity, particularly by exhibiting slow breathing during a stressor.

Age at school entry and reported symptoms of attention-deficit/hyperactivity in first graders: results of the prospective cohort study ikidS

Young age at school entry (ASE) is related to attention-deficit/hyperactivity disorder in higher grades. The reason for this association is unclear, but medical oversupply and stress-related factors are discussed. We aimed to investigate whether ASE is associated with reported symptoms of attention-deficit/hyperactivity (ADH) already in first grade. Data of a population-based prospective cohort study (N = 2003; Mainz-Bingen region; Rhineland-Palatinate; Germany) with baseline assessments prior to school entry and two follow-ups during first grade were analysed. ADH symptoms were assessed by parent and teacher versions of the Strengths and Difficulties Questionnaire. Associations between ASE and scores of the hyperactivity/inattention subscale (range 0-10) were investigated by regression analysis and adjusted for potential confounders and baseline symptoms prior to school entry. In total, 1633 children (52% boys, mean ASE 6.5 years) were included. There were no relationships between ASE and parent-reported scores of the hyperactivity/inattention subscale prior to school entry and 3 months thereafter. However, at the end of first grade, ASE was negatively associated with the hyperactivity/inattention subscale in parent (- 0.7 subscale points per year ASE, standard error = 0.16, p < 0.0001) and teacher reports (- 1.2 subscale points per year ASE, standard error = 0.25, p < 0.0001). This ASE effect appeared more pronounced in girls than in boys. Young ASE is related to more reported symptoms of ADH at the end of first grade, but not before. The evolvement of this effect during first grade may be a clue to ASE-related stress factors.

Adolescents' Personality Development - A Question of Psychosocial Stress

Following the relational-developmental systems approach, this three-wave study examines whether acute stress (T2) mediates the relationship between the development of personality traits from the beginning of 8th grade (T1, M age = 15.63, SD = 0.59; 22 girls) to the end of 9th grade (T3). Using the Montréal Imaging Stress Task, which is a task that provokes acute social stress by negative social feedback, this study combined the functional magnetic resonance imaging (fMRI), heart rate, and longitudinal survey data of 41 adolescents. Mediation analysis revealed that stress-induced left insula activation partially mediates the longitudinal stability of conscientiousness. These results highlight the impact of negative social feedback during stress on students' personality development.

Academic Expectations of Stress Inventory: A Psychometric Evaluation of Validity and Reliability of the Persian Version

This study aims to evaluate the psychometric properties of the Academic Expectations of Stress Inventory (AESI) in terms of validity and reliability measurements among Persian students. A total sample of 620 high-school students (n_female = 328, n_male = 292) was recruited to complete scales on academic expectations of stress, self-efficacy, and depression. The AESI was translated from English to Persian and its translation was further checked by three experts. We used a cross-sectional research design to collect data. The results approved the internal consistency, test–retest reliability, convergent, and construct validity of the ASEI. Additionally, confirmatory factor analysis confirmed the two-factor structure of the AESI, including the expectation of self and the expectations of parents/teachers. AESI was related to depression and self-efficacy in an empirically and theoretically expected direction. Moreover, configural and metric invariance were supported by gifted vs. non-gifted groups, but not scalar. No invariance was supported by gender groups. In conclusion, the psychometric properties of the Persian version of the AESI were confirmed to be used for educational, clinical, and research purposes in Iran.

School-Related Stressors and the Intensity of Perceived Stress Experienced by Adolescents in Poland

Higher stress reactivity during adolescence is a vulnerability marker of exposure to various environmental stressors. This study aimed to investigate the association between a high level of perceived stress experienced by adolescents and stressful stimuli induced from school environment, peer, and parental relationships. The data used were from a cross-sectional, observational study conducted in a stratified sample of 1846 adolescents (13-18 years) in the Wielkopolska province, Poland. Data were collected through self-administered questionnaires and anthropometric measurements. Perceived stress was assessed using the Perceived Stress Scale (PSS-10). The association of a high level of perceived stress with school-induced exposures was determined using multivariate logistic regression after adjusting for gender, age, height and weight status and interpersonal relationships (STATISTICA 13.1). It was found that girls were over three times more likely than boys to experience a high level of perceived stress. Moreover, girls appeared to be more vulnerable than boys to school-related stressors and weight status, while boys to stressors that can arise from interpersonal relationships. School environment was the only predictor factor of high perceived stress level with a large effect size in both boys (OR = 4.45; 95% CI: 3.11-6.36) and girls (OR = 6.22; 95% CI: 4.18-7.59). Given the findings of the present study, preventive programs are critical to mitigate the effect of stress from school on adolescents' health and well-being.

Social Anxiety in 15-19 Year Adolescents in Association with Their Subjective Evaluation of Mental and Physical Health

BACKGROUND

Studies show that social anxiety in adolescence have negative impact on quality of life. The study evaluates social anxiety links with mental and physical health factors in adolescents aged 15-19 years.

METHODS

The research was performed in 2018 in secondary schools in Lithuania and included 1722 participants (46.1% males and 53.9% females). The social anxiety was assessed using Social Anxiety and Avoidance Scale for Adolescents. The main results were obtained using univariate and multivariate logistic regression analysis.

RESULTS

Total of 58.5% of adolescents were characterized by high social anxiety and 14.7% by high avoidance. Females more often were characterized by high anxiety compared to males. Multivariate logistic regression revealed that good mental health was a significant protective factor against high SA in adolescents. For females, high anxiety and avoidance were associated with living with both parents, for males, high anxiety was linked with mother's university education. Very common stomach and abdominal pain in females as well as severe and very common stomach or abdominal pain in males, increase the risk of major social anxiety.

CONCLUSIONS

High social anxiety were more prevalent between females than males and was linked with various well-being and health aspects in adolescents.

Psychological Distress, Somatic Complaints, and Their Relation to Negative Psychosocial Factors in a Sample of Swedish High School Students

Background: Adolescence is a period in life characterized by major neurobiological, physiological, and psychological changes. Those changes may give rise to worsened mental health and an increased prevalence of somatic complaints combined with a negative psychosocial environment. Rapid changes in society, which may also affect young people in several ways, call for a renewed screening of today's adolescents' mental and somatic well-being. Aim: The present study's primary aim was to measure the level of self-rated psychological distress and the prevalence of somatic complaints in a sample of Swedish high school students. As a secondary aim, it identifies gender-specific patterns and examines mental and somatic health in relation to negative psychosocial factors (such as parental alcohol use problems or the experience of physical or psychological abuse). Method: Two hundred and eighty-seven Swedish high school students completed a survey including the Brief Symptom Inventory (BSI) and a questionnaire about the presence of defined somatic complaints. In order to examine the relationship between negative psychosocial factors and mental and somatic health, three groups were formed: those reporting (i) parental substance use problems, (ii) previous experience of abuse, (iii) none of these problems. Results: The majority of the Swedish high-school students (>80%) reported no or only a few problems with psychological distress and no or only one somatic complaint. Female students disclosed a significantly higher psychological distress level captured by each BSI domain. The number of somatic complaints was similarly distributed between the genders. The students rarely reported parental substance use problems, but almost 40% of the male and 50% of the female students indicated the experience of physical and/or psychological abuse. Such negative psychosocial circumstances were related to an increased level of anxiety in the male and an increased general level of psychological distress in female students. Conclusions: The study confirmed female students' higher psychological distress level. Gender differences in the type of somatic complaints, but not in the number were detected. The experience of physical and/or psychological abuse was found to significantly worsen psychological distress in students of both genders.

School absenteeism as a potential proxy of functionality in pediatric patients with somatic symptom and related disorders

Little is known about the school functioning of youth who are medically admitted with somatic symptom and related disorders (SSRD). The current study examines school absenteeism and associated factors in medically hospitalized children and adolescents with SSRDs. Retrospective data were reviewed of 243 patients aged 5 to 18 years admitted at a pediatric hospital from 2012 to 2014, referred to the Psychiatry Consultation Service and diagnosed with an SSRD. Only 10% of patients had normal school attendance in the past year and approximately 40% had severe school absenteeism (i.e. missed > 1 month of school). No association was found between school absenteeism and caregiver report of learning difficulties/disabilities. Patients with severe school absenteeism were more likely to be between the ages of 15 and 17, with higher somatization and functional disability scores, higher rates of suicidal ideation and/or attempts, greater psychotropic medication use and psychiatry sessions during admission, and greater rates of discharge to a higher level of psychiatric care. Findings from this study suggest that screening for school absenteeism during clinical visits by use of a single question "how many school days have you (or has your child) missed this past school year," may serve as a proxy for functional disability and an indicator of psychiatric, and somatic symptom severity concerns.

Adolescents' Explanatory Models for Headaches and Associations with Behavioral and Emotional Outcomes

More than one-third of adolescents experience recurrent headaches. Usually, these headaches are of primary origin and modulated by different biological and psychosocial factors. While parents are often consulted in scientific research and medical care about the nature of their child's headache, it is unclear to what extent parents and their children agree upon the factors that cause them. Adolescents' own attributions of headaches have rarely been investigated, and it is unclear how those attributions affect behavioral and emotional outcomes. In the present study, adolescents with chronic headaches (N = 248) and their parents (N = 120) rated the influence of various biological and psychosocial factors on the adolescents' headaches. Associations between these factors and several behavioral and emotional outcomes were examined. The most frequently reported factor by both samples was stress; however, concordance between parents and adolescents was generally low. The factor "other disease" was significantly associated with medication consumption and school absence. This study is one of the first to provide insights into adolescents' own attributions of headaches. Furthermore, the significant associations of the factor with behavioral outcomes reveal the importance of understanding personal explanatory models of headache. Future studies should examine associations between subjective headache causes and the individual's experience of the disorder to improve headache interventions.

Associations of social and emotional competencies, academic efficacy beliefs, and emotional distress among students in lower secondary school

This cross-sectional study aimed to investigate how perceived social-emotional competencies (SECs), relationship skills, emotional regulation, and the ability to structure schoolwork at school and at home were associated with academic efficacy belief (AEB) and emotional distress among 1142 Norwegian eighth-grade students. The students answered an Internet-based questionnaire during school hours. Structural equation modeling was used to assess the paths of associations. In the structural model, AEB was treated as an intermediate variable predicted by the other SECs and as a predictor of emotional distress. Perceived relationship skills, emotional regulation, and the ability to structure schoolwork showed moderate to strong associations with AEB. AEB showed a strong association with emotional distress, whereas relationship skills and emotional regulation showed a moderately strong association with emotional distress. The results suggest that all SECs play a role in AEB, whereas high AEB, good perceived ability for emotional regulation, and relationship skills are linked to less emotional distress. Good perceived relationship skills, emotional regulation, and structuring of schoolwork were more strongly related to less emotional distress among females. Moreover, emotional regulation and structuring of schoolwork were more strongly associated with AEB for females. These findings may indicate that these SECs may be more essential to emotional well-being among female adolescent students.

School-related pressure and parental support as predictors of change in student stress levels from early to middle adolescence

INTRODUCTION

One major stressor of adolescents relates to the pressure students perceive from their parents accompanied by high academic expectations, while in contrast parental support is related to low levels of stress. However, it is not clear whether the perceived parental pressure and support contribute to a change in students' stress level from early to middle adolescence and if there are differences among students from low vs. high track schools.

METHODS

Thus, based on the conservation of resources theory, this two-wave study examined the role of perceived maternal and paternal pressure and support for students' general stress level from grades 8 to 9 among students attending high- and low-track schools by applying multigroup multilevel latent change modeling based on data from 1088 8^th grade students (M_Age = 13.70, SD = 0.53, 53.9% girls at Time 1).

RESULTS

Results indicate that the general stress level from early to middle adolescence increases for students from low-track schools only. This change increases even more if students from lowtrack schools perceive pressure from their fathers, whereas perceived paternal support dampen the increase of stress. For students from high-track schools, perceived maternal pressure is positively and maternal support negatively related to students' stress level in grade 8. Overall, boys tend to report lower stress levels compared to girls.

CONCLUSIONS

The findings of the present study support the conservation of resources theory, as both perceived support and pressure from parents and the educational context predict students' stress development during adolescence.

Under Pressure to Perform: Impact of Academic Goal Orientation, School Motivational Climate, and School Engagement on Pain and Somatic Symptoms in Adolescents

OBJECTIVES

Various academic factors are known to influence pain and somatic symptoms in adolescents, but the roles of academic goal orientation, school motivational climate, and school engagement are unknown. This study examined how these understudied academic factors are associated with adolescent pain and somatic symptoms and whether sex moderates the relations.

MATERIALS AND METHODS

High school students (n=90) from a high-achieving community completed questionnaires assessing academic variables, various pain characteristics, and somatic symptoms.

RESULTS

The majority of adolescents (67%) experienced pain and somatic symptoms in the past month, with 56% reporting multisite pain and 58% reporting at least 1 severe somatic symptom. Headache and abdominal pain were the most frequently reported "most bothersome" pains, and pain was rated, on average, as moderately severe, typically occurring several times per month, and was primarily chronic in nature (duration, ≥3 mo). Higher levels of ego goal orientation and perceived performance motivational climate were associated with more somatic symptoms, and ego goal orientation was also associated with more intense and frequent pain. Alternatively, greater school engagement was associated with fewer somatic symptoms. Task goal orientation and mastery motivational climate were unassociated with all pain and somatic symptom outcomes.

DISCUSSION

This study demonstrates that adolescents from a high-achieving community report more somatic symptoms and pain when they are less engaged in school and when their academic focus is on grades and outperforming peers. Results suggest that de-emphasizing competition and performance outcomes may support physical well-being in adolescents.

Too Much of a Good Thing: Social Capital and Academic Stress in South Korea

In intense academic environments such as in South Korea, students experience extreme levels of academic stress. This stress peaks as students prepare for the college entrance exam in the final year of high school. Stress is associated with a host of negative outcomes, and academic stress is the leading cause of suicidal ideation among youth in South Korea. Research suggests that in high-stress contexts such as this, social capital can improve academic success and mental health, while reducing risky or deviant behaviors. However, this research has predominantly focused on Western contexts. Because of the unique intensity of educational pursuits and intense investment in education by parents, South Korea provides a compelling case for research on the effects of family and school social capital on youth academic stress. Using data from the Korea Youth Panel Survey (N = 2753), we find that particular components of family and school social capital can both reduce and exacerbate academic stress. While measures of closeness and connection to parents reduced academic stress, school social capital had a limited impact on academic stress. Furthermore, there may be a limit to the effectiveness of social capital to help with academic stress before it becomes too much of a good thing.

Adolescents with unexplained chest pain reported depression and impaired emotional and social functioning

AIM

Chest pain is common in adolescence, but there are no established criteria for managing this problem, which is rarely associated with cardiac disease. This study addressed the gaps in the literature by evaluating psychosocial factors that could be associated with medically unexplained chest pain.

METHODS

We consecutively selected 100 patients (68% girls) aged 13-18 who were diagnosed with unexplained chest pain when they presented to the cardiology outpatient clinics of Tepecik Research Hospital, İzmir, Turkey, between 30 September 2015 and 30 June 2018. The controls were 76 age- and sex-matched adolescents (69% girls) aged 13-18 who were undergoing routine cardiology assessments before joining sports clubs. We assessed their health-related quality of life and any depression and physical symptoms.

RESULTS

Regression analysis showed some adolescents were a number of times more likely to report chest pain. These included those who reported boredom (4.1 times), felt stressed or anxious (2.2) and those who experienced sleep disturbance (2.6), co-morbid headaches (2.0), back pain (3.1) and impaired social functioning (1.2).

CONCLUSION

The results indicated a significant association between unexplained chest pain and physical symptoms, depression and impaired emotional and social functioning. These factors warrant further evaluation.

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.

School Satisfaction and School Pressure in the WHO European Region and North America: An Analysis of Time Trends (2002-2018) and Patterns of Co-occurrence in 32 Countries

PURPOSE

The purpose of the study was to examine the trends between 2002 and 2018 in school pressure and school satisfaction among 15-year-old students, across countries and by gender, in the WHO European region and North America, and explore whether there are variations between countries and by gender in the co-occurrence of school pressure and school satisfaction.

METHODS

Data from the 32 countries that participated in the Health Behaviour in School-aged Children study (HBSC) study between 2002 and 2018 were used. Statistical analyses included t-tests, binary logistic regression analyses, and chi-square tests, as required by each of the study aims.

RESULTS

School satisfaction tended to increase over the period 2002-2018 among boys, whereas school pressure increased among girls. Also, gender differences tended to dissipate in school satisfaction and generally increase in school pressure. The co-occurrence of school satisfaction and school pressure in 2017/2018 shows that the majority of students are found in the "not pressured-not highly satisfied" and "pressured-not highly satisfied" groups. There were more boys in the former group and more girls in the latter group.

CONCLUSION

Few students in the 32 countries belonged to the "not pressured-highly satisfied" group, which from a public health perspective may be seen as the most desirable group. The increases in school pressure in girls from 2002 to 2018 and their overrepresentation in the pressured groups require further attention.

The Cost of Academic Focus: Daily School Problems and Biopsychological Adjustment in Chinese American Families

Stress from daily school problems may accumulate and eventually lead to mental health issues in both youth and their parents. With a strong cultural emphasis on school performance, Chinese American families may be particularly vulnerable to such stress. In the current research, Chinese American adolescents (N = 95; Mean age = 13.7 years; 51% girls) and their parents completed daily diary reports of school problems and emotional well-being for 14 continuous days. Adolescents also provided four saliva samples per day for 4 consecutive days. Multilevel modeling analyses showed that youth's daily school problems predicted their lower happiness, higher distress, and higher total cortisol output above and beyond their emotional well-being and cortisol output the prior day. Moreover, there was a spillover effect such that youth's school problems also negatively predicted their parents' emotional well-being. Notably, the negative influence from school problems was moderated by children's cultural orientation, such that youth who were more oriented toward Chinese (vs. American) culture were more vulnerable to the school problems. Taken together, our results highlight the costs on biopsychological adjustment accompanying the academic focus in Chinese American youth and their parents.

Baseline musculoskeletal pain and impaired sleep related to school pressure influence the development of musculoskeletal pain in N = 107 adolescents in a 5-year longitudinal study

PURPOSE

This longitudinal study followed 10- to 13-year-old adolescents for 5 years to investigate the effects of juvenile musculoskeletal (MSK) pain and psychosocial risk factors on future pain. We further predicted that increased MSK pain at follow-up would be positively related to current school pressure at follow-up and negatively related to current sleep quality. Sleep quality was tested as a potential mediator of the link between school pressure and MSK pain at follow-up after controlling for baseline MSK pain.

METHODS

The baseline sample comprised 189 adolescents, and 5-year follow-up resulted in 107 15- to 18-year-old adolescents who had completed mandatory education. Adolescents responded to an online questionnaire about psychosocial stressors, MSK pain, school achievement and leisure activities. A longitudinal hierarchic linear regression including all significant baseline predictors was run to assess their impact on MSK pain 5 years later. Mediation analysis was used to investigate sleep quality as a potential mediator of the relationship between school pressure and MSK pain at follow-up.

RESULTS

Baseline MSK pain predicted MSK pain over a time lag of 5 years (ß = .26, p = .02). The relationship between follow-up school pressure and current MSK pain was mediated by sleep quality at follow-up (B = .17, SE_B = .07, 95% CI .06-.34) when baseline MSK pain was controlled.

CONCLUSIONS

Juvenile MSK pain predicts MSK pain in adolescence. A psychosocial mediation model including school pressure and sleep impairments has the potential to explain MSK pain mechanisms in adolescents. These slides can be retrieved under Electronic Supplementary Material.

Effects of Parenting Styles on Self-Regulated Learning and Academic Stress in Spanish Adolescents

Research has repeatedly highlighted the important influence of parental socialization styles on children's psychosocial adjustment. However, previous studies about their effects on school adjustment have traditionally addressed a limited set of indicators, such as academic achievement or self-concept, which should be broadened in order to increase our level of knowledge about this topic. Thus, the aim of the present study was to analyze the relationships between parenting styles and other relevant school adjustment criteria (self-regulated learning and academic stress) in adolescence. The study participants were 437 Spanish adolescents (44.7% men) from 12 to 18 years old (M = 14.55, SD = 1.80) who were enrolled in high school. A multivariate factorial design (parenting × sex × educational level) was used for each set of criteria. The results are consistent with previous research, showing that the indulgent style was related to better school adjustment during adolescence, evaluated through self-regulated learning and academic stress, thus increasing the available evidence about the influence of parenting styles in this setting. Additionally, this relationship remains invariant with regard to sex and the educational level of the participants in the study. Therefore, this study highlights the importance of parenting practices related to high acceptance/involvement for the adequate school adjustment of Spanish adolescents.

Is the effect of ill health on school achievement among Swedish adolescents gendered?

This study investigates why the relationship between health problems requiring hospitalization between the ages of 13 and 16 and school achievement (school grades in 9th grade) in Sweden was stronger for girls than for boys. We reviewed previous research on gender differences in subjective health, health care utilization and medical drug treatment to identify mechanisms responsible for this gendered effect. The relationship was analysed using retrospective observational data from several national full-population registers of individuals born in 1990 in Sweden (n = 115 196), and ordinary least squares techniques were used to test hypotheses. We found that girls had longer stays when hospitalized, which mediated 15% of the interaction effect. Variability in drug treatment between boys and girls did not explain the gendered effect of hospitalization. The main mediator of the gendered effect was instead differences in diagnoses between boys and girls. Girls' hospitalizations were more commonly related to mental and behavioural diagnoses, which have particularly detrimental effects on school achievement.

Somatic health and its association with negative psychosocial factors in a sample of Moroccan adolescents

Background:

Adolescence is a distinct developmental phase characterized by multiple physical and psychological changes and by an increased vulnerability to somatic and mental health problems. These risk and vulnerability factors are part of a complex biopsychosocial matrix, encompassing multiple factors, such as inherited biological determinants and psychological, societal, and cultural influences, which affect an adolescent’s overall wellbeing. In Morocco, similar to other developing countries, adolescents (young people aged from 15 to 19 years) constitute a substantial proportion of the population (almost 9%). However, studies about adolescents’ health in developing countries are scarce. In this study, we describe adolescents’ somatic health in a sample of high school students from the city of Tetouan, Morocco, and investigate how negative psychosocial factors, such as parental alcohol use problems and/or the experience of abuse, may influence them.

Methods:

The study sample included 655 adolescents (315 boys and 340 girls, M = 16.64 years, range = 15–18 years) from conviniently selected classes of four high schools in the city of Tetouan in Morocco. The students responded to a survey that assessed the prevalence of somatic complaints/disorders. They also indicated whether they had ever experienced physical and/or psychological abuse and whether they had parents with alcohol use problems.

Results:

More than half of the adolescents suffered from headaches and one-third had substantial problems with diarrhea or constipation. Both problems were more common in female students. The third most frequent somatic problem, affecting one in four in both genders, was allergy. Almost one-third of Moroccan adolescents (significantly more boys than girls; p = 0.004) reported no somatic complaints. In adolescents who reported parental alcohol use problems and/or experience of physical and/or psychological abuse, the prevalence of several somatic complaints (epilepsy, migraine, headache, diarrhea/constipation, gluten intolerance, allergy, and skin or thyroid disease) increased highly significantly compared to the adolescents who reported no such psychosocial environmental factors.

Conclusion:

The results suggest that only 3 in 10 urban-living Moroccan adolescents are free of somatic complaints, while the majority suffer from some somatic problems, most often headaches and diarrhea/constipation. The association of certain negative psychosocial factors with adolescents’ somatic health suggests the need of a holistic approach to the treatment of affected adolescents.

The Role of School-Related Well-Being for Adolescent Subjective Health Complaints

BACKGROUND

This study aimed to explore the prevalence of chronic specific-site and multisite pain in adolescents and to investigate how it can possibly be determined by school-related factors.

METHODS

A population-based cross-sectional study was conducted in 2014 in Lithuania as a Health Behavior in School-Aged Children (HBSC) survey. The sample consisted of 5730 school children, aged 11, 13, and 15 years. The analyzed data focused on the school-related context (relations with family, peers, and teachers; school demand, satisfaction, and bullying) of adolescents and subjective health complaints. The relationships between social support and health complaint variables were estimated using multivariate analyses.

RESULTS

The most common subjective health complaint among respondents was a headache. Backache, headache, and stomachache were more common among girls than boys. All somatic complaints were expressed more in younger ages. Multisite complaints were more common among girls and were associated with age-older ones reported more complaints. School-related bullying, school demand, satisfaction, and social support were the most relevant and independent factors for multisite somatic complaints among adolescents.

Does Sleep Mediate the Association between School Pressure, Physical Activity, Screen Time, and Psychological Symptoms in Early Adolescents? A 12-Country Study

This study examines the mediating role of sleep duration and sleep onset difficulties in the association of school pressure, physical activity, and screen time with psychological symptoms in early adolescents. Data were retrieved from 49,403 children (13.7 ± 1.6 years old, 48.1% boys) from 12 countries participating in the World Health Organization (WHO) "Health Behaviour in School-aged Children" 2013/2014 study. A validated self-report questionnaire assessed psychological symptoms (feeling low, irritability or bad temper, feeling nervous), school pressure, physical activity (number of days/week 60 min moderate-to-vigorous), screen time, sleep duration on week- and weekend days, and perceived difficulties in getting asleep. Multilevel mediation analyses were conducted. School pressure and screen time were positively associated with psychological symptoms, whereas physical activity was negatively associated. With the exception of sleep duration in the association between physical activity and psychological symptoms, all associations were significantly mediated by sleep duration on week- and weekend days and sleep onset difficulties. Percentages mediated ranged from 0.66% to 34.13%. This study partly explains how school pressure, physical activity, and screen time are related to adolescents' psychological symptoms. Future interventions improving adolescents' mental well-being could target schoolwork, physical activity, and screen time, as these behaviours are directly and indirectly (through sleep) related to psychological symptoms.

How classmates' stress affects student's quality of motivation

Over the last decades, more and more adolescents and children feel chronically stressed, which negatively affects their school performance. However, less is known whether classmates' general stress affects an individual student's quality of motivation. Therefore, based on conservation of resources theory, this study examined the precise interplay between general stress and the quality of motivation for students in high- and low-tracking schools considering potential context effects. Results of multilevel multigroup structural equation models with questionnaire data from 1,088 German students identified differences in the relation between general stress and quality of motivation for students from different school forms on both the within and between level.

Somatic Symptom Disorders in Adolescent Inpatients

PURPOSE

There are only a few reports of adolescents with somatic disorders (SDs) whose symptoms are sufficiently severe to require hospital admission. The aim of this study was to describe the symptom profile, health service utilization, and outcome of adolescents with SDs admitted to a tertiary children's hospital.

METHODS

A retrospective cohort study of all adolescents admitted to the Adolescent Medicine Unit of a tertiary children's hospital was undertaken from July 2013 to June 2014. In a two-stage process, medical records were examined to identify patients who met the diagnostic criteria for SD. Evidence of functional recovery was obtained for the period from 18 to 30 months after discharge and rated as completely recovered, partially recovered, or functionally disabled.

RESULTS

A total of 60 admissions (53 patients, 79% female) were identified with SD, accounting for 12% of the unit's admissions and 2% of hospital admissions over 12 years old. Nearly half (45%) the presenting symptoms were neurological and 39% involved pain. In total, 20% of admissions were for complex symptoms involving multiple body systems. The majority (81%) of adolescents with follow-up documentation (n = 37) demonstrated complete or partial recovery. Patients whose families fully accepted the diagnosis were more likely to accept counseling following discharge (p < .001) and were almost 20 times more likely to have completely recovered compared to adolescents whose families partially accepted or rejected the diagnosis (odds ratio 17.36, p = .003).

CONCLUSIONS

Hospitalized adolescents with SD utilize substantial resources due to the requirement for comprehensive assessment, including multidisciplinary communication. Recovery can be anticipated for the majority, especially if supported by parents.

Development and Validation of the Questionnaire of Academic Stress in Secondary Education: Structure, Reliability and Nomological Validity

This study presents the validation process of the Questionnaire on Academic Stress in Secondary Education (QASSE) designed to assess the wide variety of school sources and situations related to academic stress in adolescence, and their relationship with students’ physical and psychological well-being. The participants were 860 Spanish high school students (52.9% girls) with an average age of 14.62 years (SD = 1.8). Through a cross-validation process, results supported the QASSE multifactorial structure with four first-order factors—academic overload, interaction with classmates, family pressure, and future-oriented perspective—and a second-order factor of academic stress, showing a significant and intense relationship with adolescents’ psychological and physical well-being. Results also highlight the effects of the gender and educational level interaction on the students’ stress, with girls showing higher levels of stress in the transition courses between educational phases (sophomore and junior years). The QASSE demonstrates good validity and reliability, showing potential for both research and educational application. The results show the high impact of the QASSE dimensions on psychological and physical well-being in adolescence, highlighting its special usefulness for designing and adjusting educational prevention and intervention actions in this area to the students’ specific characteristics and needs.

Musculoskeletal pain in early adolescence: A longitudinal examination of pain prevalence and the role of peer-related stress, worry, and gender

OBJECTIVE

Adolescence is a time of change during which several health problems, such as pain problems, increase. Psychosocial mechanisms involved in this development, such as interpersonal stressors and worry, are still understudied, especially longitudinally. The first aim of this study was to investigate the prevalence of musculoskeletal pain in Swedish adolescents between the ages 13 and 15 using pain grades. The second aim was to study the role of peer-related stress, worry, and gender in the development of musculoskeletal pain problems over time.

METHODS

Adolescents in 18 public schools were followed from 7th to 9th grade (N = 1181) and answered self-report questionnaires at three time points. Prevalence was assessed at all three time points and a moderated mediation analysis investigated if peer-related stress in 7th grade predicted musculoskeletal pain two years later and if this relationship was mediated by worry in 8th grade. Gender was entered as a moderator.

RESULTS

In 7th grade, 8.4% of adolescents reported musculoskeletal pain with some functional impairment. In 8th and 9th grade around 10% of adolescents reported musculoskeletal pain problems, with girls reporting a higher prevalence than boys. Peer-related stress in 7th grade predicted musculoskeletal pain problems in 9th grade, mediated by worry in 8th grade. The mediation was moderated by gender: peer-related stress predicted worry for girls, but not for boys.

CONCLUSION

Peer-related stress and worry seem to be involved in the development of pain over time. These factors should therefore be targeted in preventative interventions and during treatment.

Development of a Shortened Version of the Adolescent Stress Questionnaire (ASQ-S): construct validity and sex invariance in a large sample of Swedish adolescents

Background

Stressor experience is an important topic of research concerning adolescent health and ill-health. For this, valid and reliable measures of adolescent stress are needed. The Adolescent Stress Questionnaire 2 was developed to tap into stressor domains specific for adolescence. Psychometric evaluations in Australian and European samples have indicated adequate psychometric properties. However, the ASQ-2 is quite extensive, which may render its use in large cohort studies, where several aspects of adolescent health are investigated, inconvenient and problematic.

Objective

To evaluate the psychometric properties of a short version of the ASQ-2 (ASQ-S) in terms of construct validity and factorial invariance across gender.

Method

The ASQ-2 was translated into Swedish and items were retained from nine of the ten scales based on factor loadings. One scale (stress of emerging adult responsibilities) was removed entirely due to low internal consistency and variance explained. The remaining 27 items were piloted and then included in an ongoing 5-year longitudinal study involving the participation of all students in the 7th and 8th grade in public schools from three Swedish municipalities (N = 2768, 47.5 % girls, mean age 13.64 years). For this study data from the first and second wave was used.

Results

A nine factor Confirmatory Factor Analysis (CFA) showed a good fit to the data and invariance across sexes was supported. The nine scales correlated positively with depressive symptoms, anxiety and worry and negatively with self-esteem. Girls reported higher stress levels than boys in eight of the nine scales. Stressors related to peer pressure predicted reported levels of anxiety and worry one year later, whereas stressors related to romantic relationships predicted depressive symptoms.

Conclusions

Overall this study suggests that the ASQ-S could be a valid measure of adolescent stressor experience and psychometrically equivalent to the full ASQ-2.

Academic Well-Being, Mathematics Performance, and Educational Aspirations in Lower Secondary Education: Changes Within a School Year

It has been suggested that both performance and academic well-being play a role in adolescent students' educational attainment and school dropout. In this study, we therefore examined, first, what kinds of academic well-being (i.e., school burnout, schoolwork engagement, and mathematics self-concept) and mathematics performance profiles can be identified among lower secondary school students (Ngrade 7 = 583, Ngrade 9 = 497); second, how stable these profiles are across one school year during the seventh and ninth grades; and, third, how students with different academic well-being and mathematics performance profiles differ with respect to their educational aspirations. By means of latent profile analyses, three groups of students in seventh grade: thriving (34%), average (51%), and negative academic well-being (15%) and four groups of students in ninth grade: thriving (25%), average (50%), negative academic well-being (18%), and low-performing (7%) with distinct well-being and mathematics performance profiles were identified. Configural frequency analyses revealed that the profiles were relatively stable across one school year; 60% of the students displayed identical profiles over time. The thriving students reported the highest educational aspirations compared to the other groups. In addition, the low-performing students in the ninth grade had the lowest educational aspirations just before the transition to upper secondary school. Practical implications as well as directions for future research are discussed.

[Psychosomatic symptoms as an expression of the deterioration of the health-related quality of life in adolescents]

Objetivo

Analizar, en una población de adolescentes escolarizados, la relación entre síntomas psicosomáticos y calidad de vida relacionada con la salud (CVRS) diferenciando por sexo y grupo de edad.

Diseño

Estudio transversal.

Emplazamiento

Cinco Institutos de Educación Secundaria.

Participantes

Ochocientos cuarenta y cuatro adolescentes de entre 15 y 18 años que cursaban 3.° y 4.° de Educación Secundaria Obligatoria y Bachillerato.

Mediciones principales

CVRS mediante KIDSCREEN-52 y síntomas psicosomáticos con la escala de problemas psicosomáticos (PSP).

Resultados

Las chicas y los adolescentes de 17-18 años presentaron síntomas psicosomáticos significativamente más altos, ambos grupos también puntuaron peor en todas las dimensiones de CVRS aunque solo alcanzaron significación las dimensiones relacionadas con bienestar físico, bienestar mental y estado de ánimo y estrés. Todos los síntomas psicosomáticos se asociaron de forma inversa con las 10 dimensiones del KIDSCREEN-52. Los modelos de regresión realizados mostraron que tristeza, dificultad de concentración y dificultad para dormir fueron los predictores de peor CVRS en ambos sexos y grupos de edad, y estas variables explicaron entre un 30 y un 41% de la varianza de la CVRS de los adolescentes.

Conclusiones

Los síntomas psicosomáticos son más frecuentes en las chicas y en los adolescentes mayores, y predictores de peor CVRS. Es importante diferenciarlos de afecciones médicas para evitar intervenciones innecesarias. Como expresiones de malestar emocional deben ser evaluados y tratados de forma integral porque interfieren en la vida cotidiana y aumentan la vulnerabilidad propia de la adolescencia.

Self-reported school demands and psychosomatic problems among adolescents - changes in the association between 1988 and 2011?

AIMS

The aim of the present study was to examine changes over time in the relationship between self-reported school demands and psychosomatic problems, also considering the impact of student influence and teacher support.

METHODS

Data from a cross-sectional study (Young in Värmland) including eight data collections (1988-2011) among Swedish students aged 15-16 were used ( n = 20,115). Analyses with multinomial logistic regression and descriptive statistics were applied.

RESULTS

Between 1988 and 2011, the proportions of students with a higher degree of psychosomatic problems increased, as did the proportion of students experiencing school demands that were too high. Finer-level analyses based on stratification of student groups did not show any associations at the aggregated level between increases of school demands and psychosomatic problems. Similarly, individual level analyses showed that the strength of the association between school demands and psychosomatic problems was not affected by year of investigation.

CONCLUSIONS

Changes in school demands over time could not explain the increasing trend in psychosomatic problems among adolescents. Since the relationship between school demands and psychosomatic problems is strong across time, there is, however, a continued need for school-based interventions. More studies are required to gain further understanding of adolescent mental health from a trend perspective.

Anxiety, depression, suicidal ideation, and stressful life events in non-cardiac adolescent chest pain: a comparative study about the hidden part of the iceberg

Chest pain in adolescents is rarely associated with cardiac disease. Adolescents with medically unexplained chest pain usually have high levels of anxiety and depression. Psychological stress may trigger non-cardiac chest pain. This study evaluated risk factors that particularly characterise adolescence, such as major stressful events, in a clinical population. The present study was conducted on 100 adolescents with non-cardiac chest pain and 76 control subjects. Stressful life events were assessed by interviewing patients using a 36-item checklist, along with the Children's Depression Inventory and Spielberger's State-Trait Anxiety Inventory for children, in both groups. Certain stressful life events, suicidal thoughts, depression, and anxiety were more commonly observed in adolescents with non-cardiac chest pain compared with the control group. Moreover, binary logistic regression analysis showed that trouble with bullies, school-related problems, and depression may trigger non-cardiac chest pain in adolescents. Non-cardiac chest pain on the surface may point to the underlying psychosocial health problems such as depression, suicidal ideas, or important life events such as academic difficulties or trouble with bullies. The need for a psychosocial evaluation that includes assessment of negative life events and a better management have been discussed in light of the results.