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

Mental health profiles of 15-year-old adolescents in the Nordic Countries from 2002 to 2022: person-oriented analyses

BACKGROUND

Studies of time trends in Nordic adolescents' mental health have often relied on analyses of adolescents' psychosomatic symptoms. In this study, we examine adolescents' self-reports on mental health in the context of the dual factor model, which encompasses both overt manifestations of mental health symptoms and subjective perception of one's health status.

METHOD

The objective of this study was to employ a person-oriented approach utilizing cluster analysis to discern time trends in mental health profiles of Nordic adolescents, using their psychosomatic complaints and their perception of their overall health as cluster variables. The resulting health profiles were then subjected to a comparative analysis with regard to different measures of psychological and social adjustment. The mental health profiles were based on data from the Health Behaviour in School-aged Children (HBSC) survey, which was conducted among almost 50000 15-year-olds in five Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) between 2002 and 2022.

RESULTS

Mental health profiles exhibiting comparable content were observed in all Nordic countries, including profiles indicating adequate health, perceived good health, perceived poor health, high psychosomatic complaints, and dual health problems (defined as both high psychosomatic complaints and perceived poor health). These health profiles showed similar trends over time in the Nordic countries. Significant gender differences were observed. In 2002, adequate health was the dominant profile for both sexes. After 20 years, however, the high psychosomatic profile became the most common profile among girls. Among the three risk profiles, namely perceived poor health, high psychosomatic complaints and dual health problems, adolescents in the dual problems profile had the most psychological and social adjustment problems.

CONCLUSIONS

The comparatively lower incidence of adjustment problems among adolescents in the high psychosomatic profile relative to the dual mental health group challenges the prevailing view that there has been a sharp increase in mental health problems among Nordic adolescents. This view was largely based on the observed rise in psychosomatic symptoms. Indeed, there was a doubling in the proportion of adolescents in the high psychosomatic complaints profile between 2002 and 2022. This increase was considerably more pronounced than that observed for the dual health problems profile which exhibited most problems.

COVID-19 Pandemic School Disruptions and Acute Mental Health in Children and Adolescents

Importance

There are suggestions that school pressure may be stressful and a factor in child and adolescent mental health disturbances, but data about this association are scarce and inconclusive.

Objective

To assess whether varying degrees of school interruption were associated with changes in emergency department (ED) psychiatric visits of children and adolescents before and after the COVID-19 outbreak.

Design, Setting, and Participants

A cross-sectional observational study was conducted at 9 urban university hospitals in Italy. All ED visits from January 1, 2018, to December 31, 2021, for psychiatric reasons of patients younger than 18 years were examined for demographic characteristics and type of psychopathologic factors. Data analysis was conducted from July 1 to August 31, 2023.

Exposure

The disruption in the usual succession of school and holiday periods brought on by the COVID-19 pandemic at different times and with various degrees of intensity.

Main Outcomes and Measures

Total number of pediatric ED visits, psychiatric ED visits, and psychiatric ED visits categorized by specific reasons (eg, psychomotor agitation, suicide ideation [SI] or suicide attempt [SA], and eating disorders) on a weekly basis.

Results

A total of 13 014 psychiatric ED visits (1.3% of all pediatric ED visits) were recorded (63.2% females; mean [SD] age, 13.8 [3.8] years). The number of ED psychiatric visits increased over time (incidence rate ratio [IRR], 1.19; 95% CI, 1.16-1.22 for each year). Significant increases in ED visits were observed for eating disorders (294.8%), SI (297.8%), and SA (249.1%). School opening, but not social lockdown restriction, was associated with an increase in the number of ED psychiatric visits (IRR, 1.29; 95% CI, 1.23-1.34), which was evident for females and for SI with SA. Socioeconomic status was associated with an increase in psychiatric visits for males (IRR, 1.12; 95% CI, 1.04-1.20) but not females (IRR, 1.04; 95% CI, 0.98-1.10).

Conclusions and Relevance

In this study, school opening was associated with an increased incidence of acute psychiatric emergencies among children and adolescents, suggesting that school can be a substantial source of stress with acute mental health implications.

Psychosomatic complaints are indicative of stress in young individuals: findings from a Swedish national cohort study

AIMS

Psychosomatic complaints are common in youth and are often assumed to indicate stress. Although several studies have confirmed that a cross-sectional association exists, few have empirically investigated whether or not perceived stress influences psychosomatic complaints. The objective of the present study was to build upon previous research by exploring whether changes in perceived stress over time are associated with corresponding changes in psychosomatic complaints. This analytical approach takes unmeasured time-invariant confounding into account, thereby offering more robust evidence for a causal association between the variables under study.

METHODS

Data was derived from the Swedish national cohort study Futura01, with information from 2,708 participants aged 17-18 in 2019 and 20-21 in 2022. Perceived stress was measured by Cohen's Perceived Stress Scale. Psychosomatic complaints were measured by questions on the frequency of stomach aches, headaches and difficulties falling asleep, which were added to an index. Information on gender, parental education, and parental country of birth was derived from registries. Linear regression analyses were conducted and the first difference (FD) approach was used.

RESULTS

Perceived stress and psychosomatic complaints exhibited cross-sectional associations at both time points. The FD analyses showed that increases in perceived stress were associated with increases in psychosomatic complaints, and this was the case irrespective of sociodemographic characteristics.

CONCLUSIONS

This study provides further empirical support for the assumption that psychosomatic complaints can be partially attributed to stress. Societal efforts aimed at reducing stressors and strengthening coping resources and strategies among young people may help mitigate perceived stress and, consequently, the likelihood of developing psychosomatic complaints.

Exploring changing trends in depression and anxiety among adolescents from 2012 to 2019: Insights from My World repeated cross-sectional surveys

AIM

Research has indicated a rise in the prevalence of depression and anxiety among adolescents over the past three decades. However, the factors underpinning increases in mental health difficulties remain poorly understood. This study examines psychological, social and environmental risk and protective factors that may explain changes in depression and anxiety among adolescents.

METHODS

Data were taken from two nationally representative My World Surveys of adolescents aged 12-19 years in 2012 (N = 5,490) and 2019 (N = 9,844). Survey data on depression and anxiety and a range of potential risk (e.g., alcohol use, psychotic symptoms) and protective factors (e.g., resilience, self-esteem) were assessed at both time points. Multiple group analyses assessed whether the predictive ability of risk/protective factors changed from wave 1 to wave 2.

RESULTS

Results showed that the prevalence of depression and anxiety increased significantly between 2012 and 2019, particularly among females. Predictors accounted for between 37% and 61% of the variance in outcomes across waves. While some risk/protective factors were consistent predictors of depression and anxiety at both waves (e.g., bullying, discrimination, optimism), reporting female gender and having higher formal help-seeking tendencies more strongly predicted anxiety at wave 2, while lower self-esteem and lower resilience (personal competence) strongly predicted both depression and anxiety at wave 2.

CONCLUSION

Findings highlight the need to prioritize adolescent mental health service provision, especially in females. Self-esteem and resilience are potentially important targets for supporting adolescent mental health. Further research is required to understand the causal factors associated with increases in anxiety and depression.

Measuring mental wellbeing in clinical and non-clinical adolescents using the COMPAS-W Wellbeing Scale

Introduction

Adolescence is a key period of vulnerability for poor mental health as the brain is still developing and may be more sensitive to the negative impacts of stress and adversity. Unfortunately, few measures comprehensively assess wellbeing in adolescents.

Methods

The 26-item COMPAS-W Wellbeing Scale for adults was validated in a sample of 1,078 adolescents aged 13-17 years old (51.67% male, 79.13% non-clinical vs 20.87% psychiatric or developmental clinical cases). The six COMPAS-W sub-scales and total scale were examined in this sample using second-order confirmatory factor analysis, and psychometric testing.

Results

The 23-item COMPAS-W demonstrated the best fit for this sample according to goodness-of-fit indices (χ 2 (220, 1078) = 1439.395, p < 0.001, CFI = 0.893, TLI = 0.877, RMSEA = 0.070, SRMR = 0.095). Internal reliability for the confirmed 23-item COMPAS-W model was run for the total scale (α = 0.912) and sub-scales (Composure, α = 0.735; Own-worth, α = 0.601; Mastery, α = 0.757; Positivity, α = 0.721; Achievement, α = 0.827; and Satisfaction, α = 0.867). Test-retest reliability over 6 weeks was also good for the total scale at r = 0.845 and the sub-scales: Composure (r = 0.754), Own-worth (r = 0.743), Mastery (r = 0.715), Positivity (r = 0.750), Achievement (r = 0.750), and Satisfaction (r = 0.812). Compared with non-clinical participants' wellbeing (M = 90.375, SE = 0.400), those with clinical diagnoses reported lower wellbeing, both for those with developmental diagnoses (M = 85.088, SE = 1.188), or psychiatric diagnoses (M = 78.189, SE = 1.758), or combined developmental and psychiatric diagnoses (M = 77.079, SE = 2.116). Yet, when wellbeing category scores were considered by diagnosis group, both non-clinical and clinical groups demonstrated incidence across all three categories of languishing, moderate and flourishing wellbeing, in support of the dual-continua model of mental health. On average, younger adolescents' (13-14 years) wellbeing did not differ from older adolescents' (15-17 years) wellbeing; however, for sex, males scored 1.731 points significantly higher in wellbeing compared with females (p = 0.028); and American participants scored 3.042 points significantly higher in wellbeing compared with Australian participants (p < 0.001).

Discussion

In conclusion, the 23-item COMPAS-W is a reliable measure of wellbeing for adolescents, both for those with and without developmental and psychiatric diagnoses.

School pressure and psychosomatic complaints among Swedish adolescents: does physical activity play a buffering role?

Background

School pressure is a significant stressor in the lives of adolescents, recognised to be associated with psychosomatic complaints. Therefore, the exploration of potential buffering factors is a relevant task. This study aimed to examine the association between school pressure and psychosomatic complaints and the potentially moderating role of physical activity in a Swedish national sample of adolescents.

Methods

Data were derived from the 2017/2018 Swedish Health Behaviour in School-aged Children (HBSC) survey, involving 3,745 participants aged 11-15 years. School pressure and physical activity were measured using single items. Psychosomatic complaints were assessed through an additive index based on the frequency of eight complaints. Covariates included gender, grade, and family affluence.

Results

Linear regression analyses demonstrated a positive graded association between school pressure and psychosomatic complaints, while an inversely graded association was observed between physical activity and psychosomatic complaints. Physical activity did, however, not moderate the link between school pressure and psychosomatic complaints.

Conclusion

Even though physical activity did not serve as a buffer, the direct effects of school pressure and physical activity on psychosomatic complaints suggest that supporting young people in managing school demands and promoting their engagement in physical activities could be effective measures in alleviating psychosomatic complaints.

Change, Adversity, and Adaptation: Young People's Experience of the COVID-19 Pandemic Expressed through Artwork and Semi-Structured Interviews

This study explores how young people's mental health was affected by the COVID-19 pandemic using artwork and semi-structured interviews. The mental health impacts of the pandemic are important to understand so that policy and practice professionals can support those affected, prepare and respond to future crises, and support young people who are isolated and restricted in other contexts. Co-designed participatory art workshops and interviews were conducted with 16-18-year-olds (n = 21, 62% female) from the London-based Longitudinal cohort Study of Cognition, Adolescents and Mobile Phones (SCAMP). Artworks and interview transcripts were qualitatively co-and analysed with young people. From interviews, six themes were identified: adaptation, restriction, change, challenges, overcoming adversity, and lockdown life. From the artwork, four themes were identified: trapped, negative mental wellbeing, positive emotions, and technology. Everyday factors such as home environment, social support, hobbies, habits, and online education were key determinants of how challenged and restricted participants felt, and their capacity to overcome this. This demonstrates the importance of wider (social and environmental) determinants and supports a systems-level public health approach to young people's mental health. For example, young people's mental health services should collaborate with other sectors to address such determinants in a holistic way. Clearer guidance and support with occupation, relationships, environment, routine and activities could mitigate the negative mental health impacts of major environmental changes on young people.

Problematic social media use and psychological symptoms in adolescents

PURPOSE

This study examined time trends in significant child and adolescent psychological symptoms and explored the association of frequent and problematic social media use with these symptoms.

METHODS

Time trends in psychological symptoms were assessed using data from five waves of the international survey of Health Behavior in School-aged Children (HBSC), conducted between 2001 and 2018 (N = 1,036,869). The associations of frequent and problematic social media use with significant psychological symptoms were assessed by hierarchical multinomial logistic regression using data from 2001-2002 and the 2017-2018 survey waves. The direction of effect between social media use variables and psychological symptoms was explored using Linear Non-Gaussian Acyclic Models (LiNGAM).

RESULTS

Prevalence of more severe psychological symptoms increased from 6.7% in 2001-2002 to 10.4% in the 2017-2018 survey waves. The increase was especially large among 15-year old and older girls: from 10.9 to 19.1%. The higher prevalence of more severe psychological symptoms in 2017-2018 compared with 2001-2002 was eliminated after adjusting the model for problematic social media use. LiNGAM analysis supported the direction of effect going from social media use and problematic social media use to psychological symptoms.

CONCLUSIONS

The findings suggest that frequent and problematic use of social media contribute to the increasing trend of psychological symptoms in adolescents in recent years.

Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century - trends, causes, consequences

Internalizing conditions of psychopathology include depressive and anxiety disorders; they most often onset in adolescence, are relatively common, and contribute to significant population morbidity and mortality. In this research review, we present the evidence that internalizing conditions, including depression and anxiety, as well as psychological distress, suicidal thoughts and self-harm, and fatal suicide, are considerably increasing in adolescent populations across many countries. Evidence indicates that increases are currently greatest in female adolescents. We present an epidemiological framework for evaluating the causes of these increases, and synthesize research on whether several established risk factors (e.g., age of pubertal transition and stressful life events) and novel risk factors (e.g., digital technology and social media) meet conditions necessary to be plausible causes of increases in adolescent internalizing conditions. We conclude that there are a multitude of potential causes of increases in adolescent internalizing conditions, outline evidence gaps including the lack of research on nonbinary and gender nonconforming populations, and recommend necessary prevention and intervention foci from a clinical and public health perspective.

Trends in mental health problems among Swedish adolescents: Do school-related factors play a role?

AIM

The aim of this study is to investigate the extent to which school-related factors, such as school liking, participation in decision-making, school-related parental support, teachers' support, and school physical environment, explain trends in mental health problems. The problems considered are psychosomatic symptoms (PSS), depressive symptoms (DS), suicidal ideations (SI), and suicide attempts (SA) among Swedish adolescents of varying socioeconomic status (SES) from 2004 to 2020.

METHODS

We analyzed data collected through repeated cross-sectional surveys from 19,873 15-year-old students at schools in a county in Sweden. Boys and girls each constituted 50% of the participants. We fitted linear and logistic regression models to investigate associations between the school-related factors and trends in mental health problems.

RESULTS

Increased school-related parental support and school liking were cross-sectionally associated with decreased PSS, DS and SI, with school liking also associated with decreased SA. Conducive school physical environment was also found to be cross-sectionally associated with lower PSS and DS scores. Over time, mental health problems have shown a general increase among adolescents in the low SES group and a decrease among those in the high SES group. While school-related factors explained the improvement in mental health in the high SES group, we found such association only between parental support trends in PSS and DS, along with participation and trends in SA over time among adolescents in the low SES group.

CONCLUSIONS

The results show that school-related factors play significant roles in influencing adolescent mental health. The influence, however, varied across SES gradients over time. This suggests that working against inequities in school-related factors would help address inequities in mental health.

Gender differences in Russian adolescent mental health from 1999 to 2021

This study examined secular trends in Russian adolescent mental health, the specific effects of the COVID-19 pandemic, and associations with country-level indicators. A cross-sectional survey of 12,882 adolescents aged 11-18 years was carried out between 1999 and 2021 using the Strengths and Difficulties Questionnaire. The results showed an incline in girls' internalizing problems with a two-fold increase in the gender gap. There was a decline in girls' prosocial behavior and an incline in peer problems, with decreasing gender differences. Conduct problems showed a reversal of gender differences. Changes during the pandemic were not greater than over-time changes, with the exception of inclines in hyperactivity-inattention in both genders. Time trends in adolescent mental health were associated with over-time changes in national indicators of wealth and gender equality. The findings provide a strong basis for further research into the determinants of gender differences in adolescent mental health and for gender-specific interventions.

Secular trends in mental health problems among young people in Norway: a review and meta-analysis

There is a growing concern that the mental health of recent generations of youth is deteriorating, yet the etiology of these secular changes is not fully understood. We aimed to review the evidence on trends in mental health problems among young people in Norway. Seven large-scale repeated cross-sectional studies were included in this study, comprising 35 cross-sectional data collections between 1992 and 2019, with a total sample of 776,606 young people. Our study found a clear increase in mental health problems among young females in Norway over the past few decades, while the trends were less marked for males. The proportion of individuals scoring above the problematic symptom score threshold increased on average by 11.2% (range 2.2% to 21.9%) for females and 5.2% (range - 0.9% to 11.1%) for males, based on data from the individual studies. The results from a meta-regression analysis showed that across all surveys, mean symptom scores increased by 17% (95% CI 12 to 21%) among females and 5% (95% CI 1 to 9%) among males from 1992 to 2019. Overall, mental health problems have increased continually since the early 1990s among young people, especially among young females. The cause of these secular changes remains unknown but likely reflect the interplay of several factors at the individual and societal level.Protocol registration: Open science framework, November 8, 2021 ( https://osf.io/g7w3v ).

Increases in Sleep Difficulties and Psychological Symptoms are Associated With the Increase of Chronic Back Pain in Adolescents: The HBSC Study 2002 to 2018

Cross-national research using data from the Health Behavior in School-aged Children (HBSC) survey showed an increase in the prevalence of chronic back pain from 2002 to 2014. However, it is unknown if this trend has persisted beyond 2014. The aims of this study were to 1) determine if the prevalence of chronic back pain in girls and boys aged 11, 13, and 15 continued to increase from 2014 to 2018 and if this was the case, 2) examine whether this increase in the prevalence of chronic back pain between 2002 and 2018 was explained indirectly by increases in sleep difficulties and psychological symptoms. Data from 7,89,596 adolescents retrieved from 5 waves of the HBSC survey conducted in 2002, 2006, 2010, 2014, and 2018 in 32 countries/regions were used. Logistic regressions and path analyses were conducted. Results showed an overall increase of .5% in the prevalence of chronic back pain between 2014 and 2018, ranging from .4% for 15-year-old girls to 1.3% for 11-year-old boys, indicating a continued overall increase in chronic back pain in adolescents beyond 2014. For 13-year-old girls and for 15-year-old girls and boys, the increase in the prevalence of chronic back pain between 2002 and 2018 was partially mediated by increases in sleep difficulties, which in turn were associated with increases in psychological symptoms. The findings provide important information that may aid stakeholders in enhancing public health initiatives to prevent or reduce the increasing trend in the prevalence of chronic back pain in adolescents. PERSPECTIVE: This study shows that chronic back pain prevalence continues to increase among adolescents, with sleep difficulties and psychological symptoms contributing significantly to this trend. The findings provide insights that may inform strategies to prevent or reduce the increasing trend of chronic back pain in adolescents.

Sexual Attraction Disparities in Adolescent Mental Health: The Role of School Norms

Purpose: Few studies examine whether and how heterosexist norms in schools might influence disparities in mental health between sexual minority and heterosexual adolescents. Addressing this gap, we study disparities in life satisfaction, psychosomatic complaints, and emotional problems between same/both-sex attracted and other-sex attracted adolescents and examine the moderating role of heterosexist norms on the classroom- and school-level. Methods: We used data from the 2013 and 2017 Dutch Health and Behavior in School-Aged Children study (N = 12,756; mean age = 14.02; standard deviation = 1.54). Separate multi-level analyses for life satisfaction, psychosomatic complaints, and emotional problems were conducted in which cross-level interaction effects between sexual attraction and school and classroom-level heterosexist norms were estimated. Results: Same-sex attracted, both-sex attracted, and adolescents unsure about their sexual attraction reported lower life satisfaction, more psychosomatic complaints, and more emotional problems than their other-sex attracted peers. On average, stronger school-level heterosexist norms were associated with higher life satisfaction, fewer psychosomatic complaints, and fewer emotional problems. Stronger classroom-level heterosexist norms were associated with fewer emotional problems. One moderating effect of sexual attraction and school-level heterosexist norms was found. Contrary to expectations, disparities in life satisfaction between same-sex attracted and other-sex attracted adolescents were smaller when classroom-level heterosexist norms were stronger. Standardized regression coefficients showed that the associations were small. Conclusion: Although our findings suggest pressing health disparities between heterosexual and sexual minority adolescents, heterosexist norms at the school and classroom level were weakly associated with these health disparities.

The Association of Physical Activity and Stress-induced Neurocognitive Impairments in Inhibitory Control in Children

Background

Evaluation stress can impair inhibitory control, limiting the ability of children to perform cognitively. However, evidence on protective factors is lacking as stress-induced cognitive impairments are poorly understood. High physical activity has been related to better inhibitory control and has the potential to buffer the response to a stressor. We investigated the association of physical activity and stress-induced changes in inhibitory control as well as its underlying cognitive control processes (i.e., conflict monitoring and resolution).

Method

Participants (10 to 13 y) with either low (N = 55) or high moderate-to-vigorous physical activity (N = 55) completed the Trier Social Stress Test for Children (TSST-C) and a control task in a randomized order. During both conditions, salivary cortisol was collected. Additionally, a computerized Stroop task was administered before and after the experimental conditions. The N200 and positive slow wave (PSW) components of event-related potentials elicited by the Stroop task were recorded using electroencephalography.

Results

In comparison to the control task, the TSST-C elicited a pre-to post-test decrease of accuracy on incompatible trials. Path-analyses further revealed that this decrease was related to low physical activity and a reduced PSW amplitude. However, both the N200 and PSW amplitudes did not mediate the relation between physical activity groups and performance on the Stroop task.

Conclusion

In children, evaluation stress decreases inhibitory control partly due to a reduced effectiveness of conflict resolution processes. Only children with high physical activity maintain inhibitory control after facing the stressor. However, this protective effect cannot be attributed to changes in conflict monitoring and resolution.

Impact of the Japanese Government's 'General Principles of Suicide Prevention Policy' on youth suicide from 2007 to 2022

BACKGROUND

The Japanese Government programme 'General Principles of Suicide Prevention Policy' (GPSPP) contributed to decreasing suicide mortality rates (SMRs) before the COVID-19 pandemic, but they increased after the pandemic.

AIMS

To identify risk factors for youth suicide and the impact of GPSPP on youth suicide.

METHOD

Annual suicide numbers during 2007-2022 were obtained from government databases. SMRs of student and non-student youths were analysed with a linear mixed-effects model. Interrupted time-series analysis was conducted to investigate temporal relations between three GPSPP periods and SMRs with 52 suicide motives among high school, special vocational school and university students. Multiple regression analysis was conducted to investigate the influence of grade repetition on university student SMRs.

RESULTS

Non-student youth SMRs were higher than student SMRs. School-related (worrying about the future/underachievement), health-related (mainly mental illness) and family-related (conflict with parent and severe verbal reprimands) motives were major motives for student SMRs. During the first GPSPP period (2007-2012), no student SMRs decreased. During the second period (2012-2017), university and special vocational school student SMRs increased, but high school student SMRs were unchanged. In contrast, during the third period (2017-2022), with the exception of male special vocational school students, all SMRs increased. Unexpectedly, long-term grade repetition was negatively associated with health-related SMRs.

CONCLUSIONS

These findings suggest that GPSPP-supported programmes in schools partially contributed to student suicide prevention. To suppress increasing student SMRs, social/life support specialists should participate in in-school support services to bolster the social standing and lives of students who repeat grades or experience setbacks.

Adolescent social media use: cultivating and constraining competence

According to self-determination theory competence is a basic psychological need that is crucial for wellbeing. Social contexts strongly influence whether competence is supported or thwarted. Given that social media is a pervasive social context within adolescents' lives, it can play a crucial role in competence development. Three qualitative methods were used to investigate mid-adolescents' perspectives of how their social media use impacts competence. Participants included 36 students aged 15 years from four Australian schools. All participants completed a rich picture mapping activity and focus group discussions. A sub-sample of 11 students participated in follow-up interviews. Reflexive thematic analysis generated two overarching themes. The first theme cultivating competence includes sub-themes; enhancing social competencies, mastery experiences and goal accomplishment, and social media expertise. The second theme constraining competence includes sub-themes; ineffectance within the social media environment, interfering with sleep, and hindering learning. Findings demonstrated that social media contributes to today's adolescents encountering unique experiences with regards to competence development. Furthermore, adolescents' interactions on social media have broad implications for competence within online and offline realms. This study identifies aspects of social media use that can be targeted to help adolescents engage with social media in ways that cultivate rather than constrain competence.

Prospective associations between psychosomatic complaints in adolescence and depression and anxiety symptoms in young adulthood: A Swedish national cohort study

Background

Psychosomatic complaints are reported by high shares of adolescents in Sweden and elsewhere. Yet, little is known about to the extent to which the frequency, number, and persistence of such complaints in adolescence are associated with subsequent mental health problems. The aim of this study was to examine how the frequency, number, and persistence of psychosomatic complaints in middle and late adolescence are associated with depression and anxiety symptoms in young adulthood.

Methods

A Swedish national cohort study of adolescents who were surveyed in 2017 (t1; age 15-16), in 2019 (t2; age 17-18) and in 2022 (t3; age 20-21 years) was used. Psychosomatic complaints were measured by questions on stomach ache, headache and difficulties falling asleep at t1 and t2. Depression and anxiety symptoms were measured by the Patient Health Questionnaire-4 (PHQ-4) at t3. Multivariable binary logistic regression analyses stratified by gender were based on data from t1, t2 and t3 (n = 2779).

Results

The frequency, number, and persistence of psychosomatic complaints during adolescence were associated with symptoms of depression and anxiety in young adulthood. Both earlier (at t1 only) and more recent (at t2 only) complaints were linked to subsequent depression and anxiety symptoms, while persistent (at both t1 and t2) psychosomatic complaints showed stronger associations in girls.

Conclusions

Psychosomatic complaints in adolescence were associated with depression and anxiety symptoms in young adulthood. This was true for the frequency, number, and persistence of psychosomatic complaints. Among girls, those who reported persistent psychosomatic complaints from middle to late adolescence had the highest likelihood of reporting subsequent depression and anxiety symptoms. Taken together, the results indicate that psychosomatic complaints during adolescence can translate into later depression and anxiety symptoms. Furthermore, repeated measurements of psychosomatic complaints can be used to identify the most vulnerable group.

How do adolescents experience the decision-making process on travel mode choice?

Active travel can contribute to multiple health benefits in youth. Previous research has identified several factors influencing travel behavior. This study investigates how adolescents process these factors during their decision-making process on travel mode choice. Semi-structured interviews were conducted with 13 adolescents (11-14 years) and analysed using deductive-inductive thematic analysis. Four themes were generated from which the decision-making process on mode choice was conceptualized according to adolescents. The step-by-step process in which travel mode options were gradually reduced, was dependent on the context (Theme 1), the perceived availability of travel mode choice options, which was influenced by factors beyond the individual's perceived control (Theme 2), and on adolescents' pros/cons assessment to identify the most convenient option. Adolescents' habitually used travel mode influenced the decision at several stages throughout the process (Theme 4). To promote healthy travel behaviors, interventions should consider contextual circumstances, balance between enabling autonomous choices and promoting advantages of active travel modes, address individual travel modes and include practices that foster conscious processing of decision-making.

The association between academic pressure and adolescent mental health problems: A systematic review

BACKGROUND

Academic pressure is a potential contributor to adolescent mental health problems, but international evidence on this association has never been synthesised.

METHODS

We conducted the first systematic review of the association between academic pressure and adolescent depression, anxiety, self-harm, suicidality, suicide attempts and suicide. We searched MEDLINE, PsycINFO, ERIC and Web of Science (core collection) up to November 24, 2022, for studies of school-going children or adolescents, which measured academic pressure or timing within the school year as the exposure and depression, anxiety, self-harm, or suicidal ideation, attempts or suicide as outcomes. Risk of bias was assessed using the Mixed Methods Appraisal Tool. We used narrative synthesis to summarise the evidence. The review was prospectively registered with PROSPERO (CRD42021232702).

RESULTS

We included 52 studies. Most studies assessed mixed anxiety and depressive symptoms (n = 20) or depressive symptoms (n = 19). Forty-eight studies found evidence of a positive association between academic pressure or timing within the school year and at least one mental health outcome.

LIMITATIONS

Most studies were cross-sectional (n = 39), adjusted for a narrow range of confounders or had other limitations which limited the strength of causal inferences.

CONCLUSIONS

We found evidence that academic pressure is a potential candidate for public health interventions which could prevent adolescent mental health problems. Large population-based cohort studies are needed to investigate whether academic pressure is a causal risk factor that should be targeted in school- and policy-based interventions.

FUNDING

UCL Health of the Public; Wellcome Institutional Strategic Support Fund.

The impact of the COVID-19 pandemic on adolescent mental health across the world

The global impact of the COVID-19 pandemic on adolescents has been substantial. The current review aimed to summarize the existing literature on the impact of the pandemic on mental health during adolescence, with a specific focus on longitudinal studies. The findings from these studies indicated that many adolescents experienced increased mental health problems, especially those who were already vulnerable prior to the pandemic. Several preexisting factors, such as socioeconomic background and gender, and pandemic-related factors, such as perceived stress and restrictive measures, were identified that contribute to interindividual differences in how adolescents were affected by the pandemic. However, it is crucial to interpret these changes in the context of the ongoing trend of increasing mental health problems among youth over the past decades.

Measuring child and adolescent well-being in Denmark: Validation and norming of the Danish KIDSCREEN-10 child/adolescent version in a national representative sample of school pupils in grades five through eight

KIDSCREEN-10 is a generic instrument for measuring global health-related quality of life among 8-18-year-old children and adolescents. This study examines the criterion-related construct validity and psychometric properties of the Danish language version of the KIDSCREEN-10 using Rasch models. A further aim was to construct Danish norms based on the resulting person parameter estimates from the Rasch models. Data consists of a nationally representative cross-sectional survey of 8171 children in the 5th to 8th grade of primary school in Denmark. No adequate fit to the Rasch model or a graphical loglinear Rasch model could be established for the KIDSCREEN-10 in the full sample of children (n = 8171). Results based on analyses with increasing samples sizes showed that even with the smallest sample item 3 (Kid3) of the KIDSCREEN-10 did not fit the Rasch model. After elimination of Kid3, substantial local dependence and differential item functioning relative to gender and grade level was still present. Already with a sample size of 630 fit to the Rasch model or a graphical loglinear Rasch model adjusting for local dependence and differential item functioning was not established. Therefore, generation of Danish norms was not realizable, as this requires valid sum scores and estimates of the person parameters for an adequate number of cases. Thus, the Danish language version of the child/adolescent self-report KIDSCREEN-10 questionnaire cannot be recommended for use in population-level studies. Neither can use in small sample be recommended as adjustment for differential item functioning and local dependence is ambiguous.

The Indivisibility of Parental and Child Mental Health and Why Poverty Matters

PURPOSE

To ascertain to what extent parental and children's mental health wellbeing are inter-related over time.

METHODS

We used a birth cohort study of 5,217 children in Scotland followed up from birth to adolescence. We fitted a Random Intercept Cross-lagged Panel Model for parental mental health and children's conduct problems and emotional symptoms. We included longitudinal patterns of poverty as the main covariate and some demographic control variables.

RESULTS

The effects of parental mental health and child conduct problems and emotional symptoms on one another are roughly equal in early childhood. At younger ages, parents with poorer mental health tend to negatively affect their children's conduct and the conduct problems of a child seem to impact negatively on their parents' mental health. At older ages, it is children's emotional symptoms, but not conduct problems, that tend to have a reciprocal effect on parental mental health. Regarding structural inequalities, the effect of poverty on parents' and children's mental health is categorically the largest and continues to accrue throughout the whole period, intensifying mental health problems for both parents and children over time.

DISCUSSION

Children's and parents' wellbeing is a bidirectional process. This interdependency needs to be acknowledged and addressed in policy. To foster children's wellbeing, we also need to foster parents' wellbeing. Furthermore, all interventions that address mental health and wellbeing in parents and children and that do not also tackle structural inequalities, such as poverty, will have limited success.

Understanding the dynamics emerging from the interplay among poor mental wellbeing, energy balance-related behaviors, and obesity prevalence in adolescents: A simulation-based study

Both obesity and poor mental wellbeing have a high prevalence in European youth. Adolescents in six countries identified mental wellbeing factors as main drivers of youth obesity through systems mapping. This study sought to (1) explore the dynamics of the interplay between poor mental wellbeing, energy balance-related behaviors, and adolescent overweight and obesity prevalence and (2) test the effect of intervention point scenarios to reduce adolescent obesity. Drawing on the youth-generated systems maps and a literature synthesis, we built a simulation model that represents the links from major feedback pathways for poor mental wellbeing to changes in dietary, physical activity, and sleep behaviors. The model was calibrated using survey data from Norway, expert input, and literature and shows a good fit between simulated behavior and available statistical data. The simulations indicate that adolescent mental wellbeing is harmed by socio-cultural pressures and stressors, which trigger reinforcing feedback mechanisms related to emotional/binge eating, lack of motivation to engage in physical activity, and sleep difficulty. Targeting a combination of intervention points that support a 25% reduction of pressure on body image and psychosocial stress showed potentially favorable effects on mental wellbeing-doubling on average for boys and girls and decreasing obesity prevalence by over 4%.

Stress of school performance among secondary students: The role of classroom goal structures and teacher support

With concern growing about the increasing levels of school stress among secondary school students, examining its associations with students' perceptions of important elements in classroom climate can offer valuable scientific information. However, there is minimal research about the role of perceived classroom goal structures and teacher support in school stress. In addition, most research on classroom goal structure has not made a distinction between performance-approach structures and performance-avoidance structures, which may have different effects on school stress. The aim of the present study was to examine the role of classroom goal structures and teacher support in students' stress linked to school performance. We also examined the potential moderating effect of teacher support in the association between classroom goal structures and stress. Our sample consisted of 4768 secondary school students aged 11-17 years (M_age = 13.74; 47.9% boys) from 54 schools in Andalusia, Spain. Consistent with the study's aims, hierarchical multilevel multiple regression was used to examine the relationships between mastery goal structure, performance-approach goal structure, performance-avoidance goal structure, and teacher support on our stress of school performance outcome. After controlling for gender, age, and previous academic achievement, performance-avoidance goal structure was significantly associated with higher levels of stress of school performance (p < .01). Furthermore, perceived classroom goals and teacher support tended to work together, with the role of performance-approach goal structure being dependent on the levels of mastery goal structure and teacher support (p < .05). Practical implications from these findings and future research directions are discussed.

Suicidal Mortality and Motives Among Middle-School, High-School, and University Students

IMPORTANCE

The suicide mortality rate per 100 000 population (SMRP) consistently decreased before the COVID-19 pandemic outbreak in Japan and then unexpectedly increased during the pandemic. However, the underlying mechanisms remain poorly understood.

OBJECTIVE

To identify trends in and factors associated with suicidal mortality and motives among students in Japan from 2007 to 2022.

DESIGN, SETTING, AND PARTICIPANTS

In this cross-sectional study, data on SMRPs among Japanese middle-school, high-school, and university students were obtained from the government suicide database Suicide Statistics of the National Police Agency.

MAIN OUTCOMES AND MEASURES

Age-dependent and temporal fluctuations in annual SMRPs, disaggregated by suicidal motive (7 categories and 52 subcategories), sex, and school, were analyzed using linear mixed-effect and joinpoint regression models, respectively.

RESULTS

Total suicide numbers from 2007 to 2022 were as follows: 760 male middle-school students, 635 female middle-school students, 2376 male high-school students, 1566 female high-school students, 5179 male university students, and 1880 female university students. The mean (SD) student populations from 2007 to 2022 were as follows: 1 752 737 (81 334) male middle-school students, 1 675 572 (78 824) female middle-school students, 1 648 274 (67 520) male high-school students, 1 614 828 (60 032) female high-school students, 1 652 689 (32 724) male university students, and 1 229 142 (57 484) female university students. Among male students, the leading motives were school-related factors (underachievement and worrying about the future), followed by family-related and health-related motives. Among female students, school-related and family-related motives decreased, but health-related motives showed an age-dependent increase. The SMRPs of middle-school male students and female students were almost equal (mean [SD], 2.7 [1.0] vs 2.4 [1.4]), but the age-dependent increase in SMRPs among male students was pronounced (mean [SD], high-school vs university male students, 9.1 [2.4] vs 19.6 [3.0]; high-school vs university female students, 6.1 [2.4] vs 9.6 [1.8]). However, the incidence of suicide among high-school students associated with health-related motives was greater in female students. The majority of suicides associated with major impactable suicidal motives (school-related, health-related, and family-related motives) began increasing before the pandemic. Changes in SMRP associated with interpersonal relationships, such as conflict with classmates or parents, were not significant, but the rates increased greatly during the pandemic.

CONCLUSIONS AND RELEVANCE

School-related, health-related, and family-related problems were major motives, whereas the impacts of health-related and family-related motives increased and decreased with age, respectively. Notably, most SMRPs associated with major impactable motives (underachievement, conflict with a parent or classmate, and mental illnesses) had already begun increasing in the late 2010s, indicating that recent increasing SMRPs among school-aged individuals were associated with pandemic-related factors and other factors affecting this generation before the pandemic. It may be inappropriate to uniformly apply research findings based on school-aged individuals to school-based suicide prevention programs for students in middle school, high school, and university.

Different types of screen time are associated with low life satisfaction in adolescents across 37 European and North American countries

AIMS

Prolonged screen time (ST) is a potential concern for poor wellbeing. This study aimed to examine the associations of different types of ST with life satisfaction among adolescents.

METHODS

Data were from 380,446 adolescents (aged 11-15 years, 51% girls) across 37 European and North American countries who completed the 2010 and 2014 Health Behaviour in School-Aged Children surveys. Participants reported h/day during free time spent on television, electronic games, and computer/other devices. Life satisfaction was assessed using a 10-point scale (low life satisfaction ⩽5).

RESULTS

Generalized additive modelling showed non-linear associations for each ST type, with low life satisfaction increasing monotonically for >1 h/day of electronic gaming or computer/other device and >2 h/day of watching television. Multilevel multivariable modelling showed that >4 h/day of watching television was associated with 26% higher odds for boys (OR 1.26; 95% CI:1.21-1.32) and 52% higher odds for girls (1.52; 1.46-1.59) of low life satisfaction than for ⩽1 h/day of television. Electronic gaming >4 h/day was associated with low life satisfaction with odds 42% higher in boys (1.42, 1.36-1.48) and 69% higher in girls (1.69, 1.61-1.76). A similar association was found for >4 h/day of computer/other device for boys (1.43, 1.37-1.49) and girls (1.71, 1.65-1.77).

CONCLUSIONS

Low levels of ST may be beneficial; however, prolonged periods are associated with low life satisfaction among adolescents, in particular among girls. Results support ⩽2 h/day restriction of ST and highlight research is needed to understand underlying mechanisms of ST and wellbeing, which may not reflect active versus passive content.

Time Spent on Private Tutoring and Sleep Patterns of Chinese Adolescents: Evidence from a National Panel Survey

OBJECTIVE

In recent decades, there has been a marked increase in private tutoring and a decline in sleep health among adolescents. This study aimed to outline the association between time spent on private tutoring and sleep patterns of Chinese adolescents.

METHODS

Participants were from a nationwide two-wave panel survey. We performed OLS regressions of sleep duration at wave 2 and Poisson regressions of sleep problems at wave 2 on tutoring time at wave 2, adjusting for baseline sleep duration and other covariates. Tutoring time was assessed by three items: daily hours of tutoring, daily hours of tutoring on weekdays, and daily hours of tutoring on weekends.

RESULTS

Overall, more time spent on private tutoring was associated with shorter sleep duration and more sleep problems. Furthermore, both weekday and weekend tutoring can have a positive effect on the number of sleep problems. With regard to sleep duration, weekend tutoring time played a negative role, while the effect of weekday tutoring time was negligible.

CONCLUSION

In the Chinese context, which is characterized by intense academic competition, participation in private tutoring plays a significant role in shaping students' sleep duration and sleep problems. To improve the sleep health of adolescents, the time spent on private tutoring should be carefully monitored and regulated.

Assessment of Factors Associated With Mental Well-Being Among Chinese Youths at Individual, School, and Province Levels

Importance

Although rapid urbanization in China provided improved economic prosperity and educational opportunities, it was associated with increased internalizing and externalizing problems among youths, with negative outcomes for mental well-being. Previous studies suggested that factors in individual, school, and regional levels were associated with mental well-being, and comprehensively examining these factors may provide evidence for policies for improving youth mental health.

Objective

To investigate factors associated with mental well-being at individual, school, and province levels among Chinese youths.

Design, Setting, and Participants

This cross-sectional study analyzed nationally representative data collected December 1, 2021, to January 1, 2022, from schools in China. Among 435 schools, 144 institutions had primary school students, 107 institutions had middle school students, 95 institutions had primary and middle school students, and 89 institutions had high school students. A total of 398 520 students were included.

Exposures

Characteristics at individual, school, and province levels.

Main outcomes and measures

The main outcome was mental well-being, assessed by the Short Warwick-Edinburgh Mental Well-being Scale. Linear mixed-effects models were used to investigate individual, school, and regional disparities in mental well-being among youths.

Results

There were 398 520 participants (194 460 females [48.80%]; mean [SD; range] age, 13.78 [2.40; 9-20] years). At the school level, 352 443 students (88.44%) were in public school and 291 354 students (73.11%) were in urban schools. Drinking (coefficient = -1.08; 95% CI, -1.12 to -1.05; P < .001), smoking (coefficient = -0.89; 95% CI, -0.96 to -0.83; P < .001), and increased age (coefficient per 1-year increase in age = -0.02; 95% CI, -0.03 to -0.01; P < .001) were associated with worse mental well-being. Male sex (coefficient = 1.01; 95% CI, 0.98 to 1.04; P < .001), being in a 1-child family (coefficient = 0.17; 95% CI, 0.13 to 0.20; P < .001), being in the Han group (coefficient vs other ethnic groups = 0.20; 95% CI, 0.14 to 0.26; P < .001), a higher frequency and coverage of psychological courses (eg, ≥2/wk for all students vs none: coefficient = 1.02; 95% CI, 0.36 to 1.69; P = .003), and a higher level of self-rated popularity in school (coefficient per 1-unit increase in score = 0.89; 95% CI, 0.88 to 0.89; P < .001) were associated with improved mental well-being. However, age (eg, age and 1 courses/2 wk for all students: coefficient per 1-year increase in age = -0.047; 95% CI, -0.089 to -0.005; P = .03) and sex (eg, female sex and ≥2 courses/wk for some students: coefficient = -0.184; 95% CI, -0.323 to -0.046; P = .009) had interactions with the association between psychological courses and mental well-being.

Conclusions and relevance

This study found that social disparities in mental well-being existed and that various factors at different levels were associated with mental well-being among Chinese youths. These findings suggest that public mental health programs may be recommended for associated improvements in regional disparities in mental health resources.

National-Level Schoolwork Pressure, Family Structure, Internet Use, and Obesity as Drivers of Time Trends in Adolescent Psychological Complaints Between 2002 and 2018

Little is known about societal processes that contribute to changes in adolescent mental health problems. This study aims to fill this gap using data from the Health Behavior in School-aged Children study between 2002 and 2018 (n_countries = 43, n_individuals = 680,269, M_age = 14.52 (SD = 1.06), 51.04% female), supplemented with other international data. National-level psychological complaints increased more strongly among girls than boys. National-level schoolwork pressure, single-parent households, time spent on internet, and obesity were generally rising. In both boys' and girls' samples, increases in national-level schoolwork pressure, obesity, and time spent on internet use were independently associated with increases national-level psychological complaints. However, national-level obesity and psychological complaints were more strongly related among girls than boys. Results highlight the potential impact of societal-level processes on adolescent mental health problems.

Trends in physical health complaints among adolescents from 2014 - 2019: Considering screen time, social media use, and physical activity

The rising rates of physical and mental health complaints among adolescents observed in many countries have coincided with an increased time spent on screen-based devices, including social media use. We sought to document recent trends in physical health complaints (PHC) and whether co-occurring trends in screen time, social media use, and physical activity may account for these trends. To achieve these aims, we used data from the nationwide Ungdata surveys conducted annually at the municipality level in Norway, comprising 419,934 adolescents aged 13-18 from six survey years (2014-2019). Six items assessed PHC, including neck and shoulder pain, headache, and abdominal pain, during the past month. To account for the nesting structure of Ungdata, and to exploit the variation within and between municipalities, we used multilevel analyses with adolescents nested in municipality-years (n = 669), nested in municipalities (n = 345). We found a small to moderate linear increase in number of PHC among boys and girls from 2014 to 2019. Screen time and social media use moderately attenuated the trend for girls, and to a lesser extent for boys. Screen time and social media use were further positively associated with PHC across the between and within-municipality levels, and social media use was more strongly associated with PHC for girls than boys across all levels of analysis. A similar pattern emerged when considering each symptom individually. The results suggest that the prevalence of PHC rose in tandem with a group-level shift towards higher screen time and social media use. Moreover, the results indicate that higher screen time and social media use may have led to changes in the youth culture with potential consequences for adolescents' well-being.

Prevalence and trends of common mental disorders from 2007-2009 to 2019-2022: results from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS), including comparison of prevalence rates before vs. during the COVID-19 pandemic

Up-to-date information on the prevalence and trends of common mental disorders is relevant to health care policy and planning, owing to the high burden associated with these disorders. In the first wave of the third Netherlands Mental Health Survey and Incidence Study (NEMESIS-3), a nationally representative sample was interviewed face-to-face from November 2019 to March 2022 (6,194 subjects; 1,576 interviewed before and 4,618 during the COVID-19 pandemic; age range: 18-75 years). A slightly modified version of the Composite International Diagnostic Interview 3.0 was used to assess DSM-IV and DSM-5 diagnoses. Trends in 12-month prevalence rates of DSM-IV mental disorders were examined by comparing these rates between NEMESIS-3 and NEMESIS-2 (6,646 subjects; age range: 18-64 years; interviewed from November 2007 to July 2009). Lifetime DSM-5 prevalence estimates in NEMESIS-3 were 28.6% for anxiety disorders, 27.6% for mood disorders, 16.7% for substance use disorders, and 3.6% for attention-deficit/hyperactivity disorder. Over the last 12 months, prevalence rates were 15.2%, 9.8%, 7.1%, and 3.2%, respectively. No differences in 12-month prevalence rates before vs. during the COVID-19 pandemic were found (26.7% pre-pandemic vs. 25.7% during the pandemic), even after controlling for differences in socio-demographic characteristics of the respondents interviewed in these two periods. This was the case for all four disorder categories. From 2007-2009 to 2019-2022, the 12-month prevalence rate of any DSM-IV disorder significantly increased from 17.4% to 26.1%. A stronger increase in prevalence was found for students, younger adults (18-34 years) and city dwellers. These data suggest that the prevalence of mental disorders has increased in the past decade, but this is not explained by the COVID-19 pandemic. The already high mental disorder risk of young adults has particularly further increased in recent years.

Perceived parental alcohol problems and psychosomatic complaints among adolescents in Sweden

Introduction

For adolescents, parental problem drinking can be regarded as a chronic stressor, negatively affecting their health. There is limited knowledge and a relative lack of empirical evidence on this topic, especially in Sweden. The aim of the current study was to examine perceived parental alcohol problems and the links with psychosomatic complaints among adolescents in Sweden.

Methods

Data were obtained from the Swedish Council for Information on Alcohol and Other Drugs' national survey of 2021, collected amongst 9,032 students in grades 9 (∼15-16 years) and 11 (∼17-18 years). Perceived parental alcohol problems were measured by the Children of Alcoholics Screening Test (CAST-6) scale, using a cutoff at ≥ 3. Psychosomatic complaints were captured by a binary measure based on the frequency of headache, stomach ache, feeling depressed or down, difficulties to fall asleep, and sleeping poorly at night. Sociodemographic characteristics included gender, grade, parental education, and parental country of birth. Descriptive analyses with chi2 tests and binary logistic regression analyses were performed.

Results

Adolescents with perceived parental alcohol problems had higher odds of reporting psychosomatic complaints compared with adolescents without perceived parental drinking problems, even when adjusting for sociodemographic characteristics. Girls, grade 11 students, adolescent with at least one parent born in Sweden, and those without university-educated parents were more likely to report parental alcohol problems.

Conclusions

The findings highlight adolescents with perceived parental alcohol problems need support. The school, being an arena where adolescents spend much of their time, may play a vital role in this regard.

Trends in adolescent psychosomatic complaints: a quantile regression analysis of Swedish HBSC data 1985-2017

BACKGROUND AND AIMS

According to recent criticism, survey-based measures of adolescent psychosomatic complaints have poor content validity insofar as they conflate trivial with severe complaints. It is argued that this means that estimates of prevalence and trends in complaints may reflect trivial complaints that are not indicators of health problems. In this study, two observable implications of this criticism were investigated: (a) that self-reported psychosomatic complaints should have a bimodal distribution; and (b) that the increase in complaints over time should be of approximately equal size throughout the distribution of complaints.

METHODS

Three decades (1985/1986-2017/2018) of repeated cross-sectional data from the Swedish Health Behaviour in School-aged Children survey were used. Psychosomatic complaints were measured using the screening instrument Health Behaviour in School-aged Children symptom checklist. Histograms, bar charts and quantile regression models were used for the analysis.

RESULTS AND CONCLUSIONS

With regard to the first implication, the results showed that the distribution of complaints was not bimodal and that there were no clusters of respondents. This suggests that binary categorisations of students can be reductive and conceal important variations across students. With regard to the second implication, the results showed that the increase in complaints was greatest among students who report frequent and co-occurring complaints. This suggests that reports of increasing complaints in adolescents cannot be explained as being primarily due to a greater inclination to report trivial complaints. It is concluded that any conflation of trivial and more severe complaints in surveys of psychosomatic complaints is not reflected in population-based estimates.

Worry and Psychosomatic Problems Among Adolescents in Sweden in the Wake of the COVID-19 Pandemic: Unequal Patterns Among Sociodemographic Groups?

PURPOSE

To analyze potential associations between sociodemographic factors and adolescents' worry about family finances and other types of worries during the COVID-19 pandemic and the potential associations between different worry themes and psychosomatic problems.

METHODS

From December 2020 to March 2021, 3,068 16-17 years old students in Sweden completed a questionnaire about the impact of the COVID-19 pandemic on their schooling and everyday life. From April to June 2020, 70% of these students also responded to questions about their psychosomatic health. Logistic regression was applied to analyze the associations between sociodemographic factors and different worry themes and estimate the association between worry and psychosomatic problems.

RESULTS

Across all 13 worry themes, girls reported worry to a higher degree than boys. In most of the cases, adolescents with a lower parental educational background or immigrant background reported more frequent worrying. This was most evident for worry about family finances. The differences between adolescents with a Swedish background and those with a foreign background were large except for worry about climate change. All worry themes were associated with the students' psychosomatic health. Those who often or always experienced worry were more likely to report psychosomatic problems. Worry about family finances showed the highest odds ratio and marginal effect.

DISCUSSION

Worry about family finances during the COVID-19 pandemic turns out to be a strong and socially structured stressor that may widen the health inequalities among young people. This underlines the need for preventive and promoting measures aimed at supporting socioeconomic disadvantaged groups.

Mental health profiles of Finnish adolescents before and after the peak of the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has had implications for adolescents' interpersonal relationships, communication patterns, education, recreational activities and well-being. An understanding of the impact of the pandemic on their mental health is crucial in measures to promote the post-pandemic recovery. Using a person-centered approach, the current study aimed to identify mental health profiles in two cross-sectional samples of Finnish adolescents before and after the peak of the pandemic, and to examine how socio-demographic and psychosocial factors, academic expectations, health literacy, and self-rated health are associated with the emerging profiles.

METHODS AND FINDINGS

Survey data from the Health Behaviour in School-aged Children (HBSC) study conducted in Finland in 2018 (N = 3498, age M = 13.44) and 2022 (N = 3838, age M = 13.21) were analyzed. A four-profile model using cluster analysis was selected for both samples. In Sample 1, the identified profiles were (1) "Good mental health", (2) "Mixed psychosocial health", (3) "Somatically challenged", and (4) "Poor mental health". In Sample 2, the identified profiles were (1) "Good mental health", (2) "Mixed psychosomatic health", (3) "Poor mental health and low loneliness", and (4) "Poor mental health and high loneliness". The results of the mixed effect multinomial logistic regression analysis showed that in both samples, being a girl and reporting lower maternal monitoring; lower family, peer, and teacher support; higher intensity of online communication; a less positive home atmosphere and school climate; and poor self-rated health were most strongly linked to belonging to a poorer mental health profile. In addition, in Sample 2, low subjective health literacy was a key factor associated with poorer mental health profiles, and teacher support was more important than before COVID.

CONCLUSIONS

The current study stresses the importance of identifying those vulnerable to developing poor mental health. To maximize post-pandemic recovery, the role of schools, especially teacher support and health literacy, along with the factors that remained important over time should be taken into account in public health and health promotion interventions.

Inequalities in health complaints: 20-year trends among adolescents in Scotland, 1998-2018

This study examined trends in inequalities in health complaints among early adolescents in Scotland from 1998 to 2018. We analysed data from the Health Behaviour in School-aged Children (HBSC) survey conducted in Scotland in 1998, 2002, 2006, 2010, 2014 and 2018. A self-report questionnaire was administered in schools to a nationally representative sample of 11-, 13-, and 15-year-olds (n = 29,250). Health complaints were measured using a scale comprising four psychological symptoms (feeling low, feeling nervous, irritability and sleep difficulties) and four somatic symptoms (headache, backache, stomachache and dizziness). Socio-economic status was measured using the Family Affluence Scale. Between 1998 and 2018, there were significant increases in the proportion of girls and boys reporting feeling low, feeling nervous, sleep difficulties and backache. Prevalence of the eight individual health complaints was higher among girls and adolescents from lower affluence families. Socio-economic inequalities increased over time, such that declines in mental health were greatest among low affluence adolescents. The data show worsening trends in health complaints among Scottish adolescents between 1998 and 2018, particularly for girls and adolescents from low affluence families. Increasing inequalities in mental health highlight the need to address the underlying social and structural determinants of adolescent mental health.

The Effectiveness of School-Based Skills-Training Programs Reducing Performance or Social Anxiety: Two Randomized Controlled Trials

Background

Given that high levels of stress during adolescence are associated with negative consequences, it is important that adolescents with psychological needs are supported at an early stage, for instance with interventions at school. However, knowledge about the potential of school-based programs targeting adolescents with psychological needs, aimed at reducing school or social stress, is lacking.

Objective

The current study aimed to investigate the effectiveness of two targeted school-based skills-training programs, addressing either skills to deal with performance anxiety or social skills.

Methods

Two randomized controlled trials were performed with participants who self-selected to one of the programs. The sample comprised of N = 361 adolescents (M age = 13.99 years, SD = 0.83) from various educational levels and ethnic identity backgrounds. The performance anxiety program included N = 196 participants (N = 95 in the experimental group), while the social skills program included N = 165 participants (N = 86 in the experimental group). MANCOVA's were performed.

Results

The performance anxiety program had a small effect on reducing adolescents' test anxiety. Furthermore, for adolescents who attended more than half of the sessions, the program had small effects on reducing test anxiety and fear of failure. The program did not improve adolescents' coping skills or mental health. The social skills program was not effective in improving social skills, social anxiety, and mental health.

Conclusions

A relatively short, targeted program addressing skills to deal with performance anxiety can have the potential to reduce adolescents' performance anxiety.

Trial registration

International Clinical Trials Registry Platform (Netherlands Trial Register, number NTR7680). Registered 12 December 2018. Study protocol van Loon et al., (2019).

Supplementary Information

The online version contains supplementary material available at 10.1007/s10566-023-09736-x.

Review: Digital experiences and their impact on the lives of adolescents with pre-existing anxiety, depression, eating and nonsuicidal self-injury conditions - a systematic review

BACKGROUND

Published systematic reviews provide evidence linking positive and negative digital experiences to adolescent mental health. However, these reviews focus on the general public rather than the digital experiences of adolescents with different pre-existing mental health conditions and so may be limited in their clinical relevance. We review publications relating to anxiety, depression, eating disorders and nonsuicidal self-injury to identify common and condition-specific digital experiences and how these may be implicated in the origins and maintenance of these mental health conditions.

METHODS

A systematic literature search using a combination of mental health, digital experience (including social media use), and age of the target population terms was conducted on four databases. Detailed findings from the included studies were summarised using a combination of thematic and narrative methods.

RESULTS

Five qualitative and 21 quantitative studies met the eligibility criteria for inclusion (n = 5021). Nine studies included adolescents with depression, one with eating problems, two with nonsuicidal self-injury and 14 with multiple emotional health conditions. The review identified six themes related to the target populations' digital experiences: (a) social connectivity and peer support; (b) escape and/or distraction; (c) social validation and social comparison; (d) accessing/creation of potentially harmful content; (e) cyberbullying; and (f) difficulties with self-regulation during engagement with digital media.

CONCLUSIONS

Digital practices of adolescents with pre-existing clinical vulnerabilities are complex and encompass a range of positive and negative experiences, which appear to have common elements across different clinical populations. The literature is currently too limited to identify disorder-specific practices, with too few direct or indirect comparisons between conditions.

Rapid and unequal decline in adolescent mental health and well-being 2012-2019: Findings from New Zealand cross-sectional surveys

OBJECTIVE

To investigate prevalence and trends in key mental health and well-being indicators among New Zealand secondary school students.

METHODS

Representative cross-sectional youth health surveys with 2-4% of the New Zealand secondary school population were conducted in 2001, 2007, 2012 and 2019 (total n = 34,548).

RESULTS

In 2019, 69.1% reported good well-being (95% confidence interval = [67.6, 70.6]; World Health Organization 5-item), 22.8% reported clinically significant depression symptoms (95% confidence interval = [21.4, 24.1]; Reynolds Adolescent Depression Scale-Short Form) and 41.8% reported possible anxiety symptoms (95% confidence interval = [40.5, 43.2]; Generalized Anxiety Disorder 2, adapted). Past-year prevalence of periods of low mood (38.3%, 95% confidence interval = [36.6, 40.1]), deliberate self-harm (24.1%, 95% confidence interval = [22.8, 25.4]), suicide thoughts (20.8%, 95% confidence interval = [19.2, 22.4]) and suicide attempts (6.3%, 95% confidence interval = [5.5, 7.0]) were observed. After relative stability from 2001 to 2012, there were large declines in mental health to 2019. The proportion reporting good well-being decreased (odds ratio 0.71, 95% confidence interval = [0.65, 0.78], p < 0.001), depression symptoms increased (odds ratio 1.96, 95% confidence interval = [1.75, 2.20], p < 0.001) and past-year suicide thoughts and suicide attempts increased (odds ratio 1.41, 95% confidence interval = [1.25, 1.59], p < 0.001; odds ratio 1.60, 95% confidence interval = [1.32, 1.92], p < 0.001). Past-year deliberate self-harm was largely stable. Declines in mental health were unevenly spread and were generally greater among those with higher need in 2012 (females, Māori and Pacific students and those from higher deprivation neighbourhoods), increasing inequity, and among Asian students.

CONCLUSION

Adolescent mental health needs are high in New Zealand and have increased sharply from 2012 among all demographic groups, especially females, Māori, Pacific and Asian students and those from high-deprivation neighbourhoods. Ethnic and socioeconomic disparities have widened.

Russian adolescent mental health in 2002, 2015 and during the COVID-19 pandemic in 2021

BACKGROUND

Adolescent mental health is a global concern, however, time trends and the COVID-19-related restrictions vary across countries. This study examined changes in adolescent mental health and substance use in Russia between 2002, 2015 and during the pandemic in 2021.

METHODS

Cross-sectional school-based surveys of 12- to 18-year-olds were carried out in a Siberian city in 2002 (N = 713), 2015 (N = 840) and 2021 (N = 721) using the Strengths and Difficulties Questionnaire, data on tobacco, alcohol and drug use and socio-demographic information. We examined the effect of cohort, gender, family composition and parental occupation on mental health and substance use.

RESULTS

There were increases in emotional symptoms and internalising problems (B = 0.93, p < .001) and decreases in substance use over 19 years (B = -.73, p < .001). Changes in adolescent mental health and substance use were substantial from 2002 to 2015 and nonsignificant from 2015 to 2021. Increases in mental health problems were evident only among girls; a decrease in alcohol use was larger among boys. Family composition and parental occupation did not account for these changes.

CONCLUSIONS

These results suggest that the mental health of Russian adolescent girls has worsened in the 21st century; the gender gap in mental health has widened; the gender gap in alcohol use was reversed in 2021. The findings highlight the need for research into gender-specific factors and for effective interventions. The lack of changes in Russian adolescent mental health and substance use from 2015 to during the pandemic in 2021 suggests successful coping; however, more research is needed.

The Role of Stress Experience and Demographic Factors for Satisfaction with Life in Norwegian Adolescents: Cross-Sectional Trends over a Ten-Year Period

BACKGROUND

The individual's perception of life satisfaction (LS) is regarded as a key indicator of one's overall experience of wellbeing, sensitive to the broad spectrum of functioning. Adolescence is particularly an important period for assessing LS and factors associating with LS. The present study investigated cross-sectional trends in adolescents' LS levels across three time points over a 10-year period, as well as the role of stress experience and socio-demographic differences in association with LS.

METHODS

The study used cross-sectional data from three time points: 2011 (n = 1239), 2016 (n = 1233), and 2022 (n =311), including adolescents from lower and upper secondary public schools, with an age range of 13-20 years.

RESULTS

There were relatively high and stable mean scores on LS across all time points; however, significant differences were found between 2011 and 2016. Results from the multivariate linear regression analysis showed that sex and age were moreover weakly associated with LS, where LS decreased slightly between the ages of 13 and 18 years and increased from 19 to 20 years. Of the stress domains, interpersonal and school-related stressors showed the strongest negative and significant association with LS; significant interaction effects of sex by stress domains were found, but not with sex by time.

CONCLUSION

This study supports the relatively high and stable level of LS in adolescents across the investigated time points. Demographic factors were moreover weakly associated with LS. The findings also contribute by showing the significant role of interpersonal and school-related stressors in association with LS.

The wellbeing of adolescents and the role of greenness: A cross-sectional study among Italian students

Introduction

Adolescence is a critical period of life, and the level of wellbeing acquired during this stage might have an influence on health status in adulthood. The wellbeing of adolescents is associated with both biological and environmental determinants. To date, few studies have evaluated the effect of exposure to urban green spaces (i.e., greenness) on adolescents' wellbeing. Therefore, the aim of this study is to assess the association between exposure to greenness and the wellbeing of adolescents, accounting for the level of urbanization surrounding schools.

Methods

In the frame of the 2018 Italian Health Behaviour in School-aged Children (HBSC), we analyzed cross-sectional data from the Piedmont Region. Exposure to greenness was quantified by the Normalized Difference Vegetation Index (NDVI). Schools were geocoded, and a fixed buffer (radius 1,500 m) centered on each school was then built to enable average NDVI calculations. Adolescents' wellbeing was assessed by self-reported psychological, somatic, and psychosomatic health complaints as follows. Respondents were asked how often, in the last 6 months, they had experienced: (a) headache, (b) stomachache, (c) backache, (d) dizziness, (e) feeling low, (f) irritability or bad temper, (g) feeling nervous, and (h) difficulties getting to sleep using the HBSC Symptom Checklist (HBSC-SCL), an eight-item tool. Multivariable, multilevel logistic regression models tested the association between exposure to NDVI and psychosomatic, somatic, and psychological health complaints, one at a time, using schools as a random intercept.

Results

In total, 2065 subjects (47.6% girls) aged 11 (48.4%) and 13 (51.6%) years were involved. Greenness was found to be inversely associated with reported psychosomatic (OR 0.72, 95% CI: 0.53-0.98) and psychological health complaints (OR 0.67, 95% CI: 0.49-0.92) in boys only, adjusting for age, urbanization level, and socioeconomic status, and stratifying by gender.

Discussion

Our results support the implementation of future policies for urban environmental design supporting the increase of green spaces, as suggested by the United Nations Sustainable Development Goals. Further studies are needed to confirm our findings.

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.

The great decline in adolescent risk behaviours: Unitary trend, separate trends, or cascade?

In many high-income countries, the proportion of adolescents who smoke, drink, or engage in other risk behaviours has declined markedly over the past 25 years. We illustrate this behavioural shift by collating and presenting previously published data (1990-2019) on smoking, alcohol use, cannabis use, early sexual initiation and juvenile crime in Australia, England, the Netherlands, New Zealand, and the USA, also providing European averages where comparable data are available. Then we explore empirical evidence for and against hypothesised causes of these declines. Specifically, we explore whether the declines across risk behaviours can be considered 1) a 'unitary trend' caused by common underlying drivers; 2) separate trends with behaviour-specific causes; or 3) the result of a 'cascade' effect, with declines in one risk behaviour causing declines in others. We find the unitary trend hypothesis has theoretical and empirical support, and there is international evidence that decreasing unstructured face-to-face time with friends is a common underlying driver. Additionally, evidence suggests that behaviour-specific factors have played a role in the decline of tobacco smoking (e.g. decreasing adolescent approval of smoking, increasing strength of tobacco control policies) and drinking (e.g. more restrictive parental rules and attitudes toward adolescent drinking, decreasing ease of access to alcohol). Finally, declining tobacco and alcohol use may have suppressed adolescent cannabis use (and perhaps other risk behaviours), but evidence for such a cascade is equivocal. We conclude that the causal factors behind the great decline in adolescent risk behaviours are multiple. While broad contextual changes appear to have reduced the opportunities for risk behaviours in general, behaviour-specific factors have also played an important role in smoking and drinking declines, and 'knock-on' effect from these behavioural domains to others are possible. Many hypothesised explanations remain to be tested empirically.

Secular trends in mental health profiles among 15-year-olds in Sweden between 2002 and 2018

Background

Studies of secular trends in mental unhealth indicate that adolescents in the Nordic countries, especially girls, have an increased reported prevalence of mental health problems the last decades. This increase needs to be seen in the light of the adolescents' assessments of their perceived overall health.

Objective

To investigate whether a person-centered approach to research can enhance understanding of changes over time in the distribution of mental health problems among Swedish adolescents.

Method

A dual-factor approach was used to study changes over time in mental health profiles among nationally representative 15-year-old adolescent samples from Sweden. Cluster analyses of subjective health symptoms (psychological and somatic) and perceived overall health from the Swedish Health Behavior in School-aged Children (HBSC) surveys of 2002, 2006, 2010, 2014, and 2018 were used to identify these mental health profiles (n = 9,007).

Results

Four mental health profiles were identified by a cluster analysis which combined all five data collections-Perceived good health, Perceived poor health, High psychosomatic symptoms, and Poor mental health. There were no significant differences in the distributions of these four mental health profiles between the survey years 2002 and 2010, but substantial changes took place between 2010 and 2018. Here, particularly the High psychosomatic symptoms profile increased among both boys and girls. The Perceived good health profile decreased among both boys and girls, and the Perceived poor health profile decreased among girls. The profile involving the most pronounced mental health problems, the Poor mental health profile (perceived poor health, high psychosomatic problems), was stable from 2002 to 2018 among both boys and girls.

Conclusion

The study shows the added value of using person-centered analyses to describe differences in mental health indicators between cohorts of adolescents over longer periods of time. In contrast to the long-term increase in mental health problems seen in many countries, this Swedish study did not find an increase among young persons, both boys and girls, with the poorest mental health, the Poor mental health profile. Rather, the most substantial increase over the survey years, predominantly between 2010 and 2018, was found among the 15-year-olds with High psychosomatic symptoms only.

Seasonal suicide trends in adolescents in the US: Did they explain the apparent effect of the Netflix show 13 Reasons Why?

INTRODUCTION

Controversy surrounds the effects of the first season of the Netflix show 13 Reasons Why on adolescent suicide in the United States. This research reexamined the question using more sensitive weekly suicide counts and more sensitive tests for seasonal changes in suicide.

METHODS

Weekly suicide counts for adolescents ages 10-19 and young people ages 20-29 obtained from CDC were analyzed from 2013 to 2018 NVSS Mortality Data using time series methods.

RESULTS

Adolescents ages 10-19 exhibited seasonal changes in suicides that increased from March to April and that also paralleled the school year. The same seasonal pattern was evident in males ages 20-24. There was no evidence of an effect of 13 Reasons in male adolescent suicides in 2017 once seasonality, auto-correlation, and longer term trends were removed.

CONCLUSION

Seasonal changes and secular increases can explain why previous studies observed suicide increases in March and April of 2017 in male adolescents. The association between school year and suicide suggests that stressors associated with schooling increase the risk of suicide in some youth. How to reduce these risks is an important focus for future research as is the need to understand the conditions under which fictional depictions of suicide lead to contagion.