Psychosocial problems in adolescents associated with frequent health care use

Parent-adolescent communication quality does not moderate the association of emotional burden and somatic complaints in adolescents: a cross-sectional structural equation model

An explanation for somatic complaints in adolescence assumes that they have the function to express emotional burden if the communication of feelings in important relationships does not work sufficiently. Therefore, it can be hypothesized that in adolescents, lower quality of emotional communication with a parent goes along with a higher impact of emotional burden on somatic complaints. The aim of this study was to examine whether emotional communication quality between adolescents and parents moderates the association of emotional burden and somatic complaints. Based on data from a cross-sectional population sample (N = 1061), structural equation modeling (SEM) was used to test the hypothesis. In addition to the general model, models for boys and girls were compared. Emotional communication quality does not moderate the association of emotional burden and somatic complaints in the general model or in the gender-based models. However, communication quality is a significant predictor of somatic complaints for boys. Limitations are the cross-sectional nature of the data, the possible sampling bias due to the use of an online access panel, and the inclusion of one parent per adolescent. This study highlights that emotional communication quality is a predictor for somatic complaints in adolescent boys and should be addressed in therapy.Trial registration ClinicalTrials.gov: NCT05332236.

Profile and healthcare utilisation patterns of adolescent frequent attenders in Singapore primary care: a retrospective study

OBJECTIVES

Frequent attenders (FAs) visit healthcare settings at higher rates compared with the general population and use disproportionate amounts of healthcare resources. Frequent attendance (FA) has also been associated with greater morbidity and adverse socioeconomic circumstances. Our study aimed to describe the sociodemographic profile, clinical presentation, and healthcare utilisation patterns of adolescent FAs at polyclinics in Singapore and to determine the factors associated with adolescent FA.

DESIGN

Retrospective electronic database analysis.

SETTING

A cluster of eight state-subsidised public primary care clinics (polyclinics).

PARTICIPANTS

Multiethnic Asian adolescents aged 10-19 years who attended the eight polyclinics in 2021. FAs were defined as the top 10% of clinic attendees in terms of annual visit frequency.

RESULTS

In 2021, 34 645 adolescents attended the polyclinics for 75 902 visits. Visits were for acute (52.8%), chronic (26.2%) and preventive (27.7%) care. FAs attended ≥4 visits annually, accounting for 14.4% of adolescents and 42.5% of total attendances. Compared with non-FAs, FAs were older (OR 1.16, 95% CI 1.15 to 1.18, p<0.001), more likely to be of non-Chinese ethnicity, and have received financial aid (OR 1.68, 95% CI 1.58 to 1.79, p<0.001). FAs had more underlying psychiatric conditions (p<0.001) but presented less frequently with psychiatric complaints (p<0.001). FAs were more likely to be referred to emergency departments (p<0.001) and psychiatry clinics (p<0.001), to be prescribed potentially addictive medication (p<0.001), and had longer annual medical leave certification (7 days (IQR=4-11) vs 3 days (IQR=1-3, p<0.001)).

CONCLUSION

Adolescent FA was associated with increasing age, non-Chinese ethnicity and lower socioeconomic status. Despite having more underlying psychiatric conditions, adolescent FAs presented more frequently with acute physical complaints instead of psychiatric symptoms. Adolescent FAs had longer annual medical leave certification and greater healthcare utilisation indicated by more clinic visits and referrals to emergency departments and psychiatry clinics.

The use of youth healthcare services and its association with health-related quality of life, physical and mental health and over-the-counter analgesics use in 13-19-year-old adolescents: a cross-sectional study

BACKGROUND

Youth healthcare services in Norway include a public health nurse (PHN) at school and local youth health centres (YHCs). They provide health services for all adolescents free of charge, focusing on health promotion and disease prevention. The present study aimed to assess possible associations between health-related quality of life (HRQoL), physical and mental health, over-the-counter analgesics (OTCA) use and use of youth healthcare services among 13-19-year-old adolescents.

METHODS

This study was based on national, cross-sectional data from the Ungdata Survey conducted in 2022. The sample was comprised of 16 482 adolescents. Multiple logistic regression was used to analyse the associations between HRQoL, headaches, selected physical symptoms, psychological distress, use of OTCA, PHN availability, sociodemographic variables, and use of the PHN at school or at a YHC. The KIDSCREEN-10 was used to measure HRQoL, and the Hopkins Symptoms Checklist 10 was used to measure symptoms of psychological distress.

RESULTS

Girls used the youth healthcare services more frequently than boys. Better HRQoL was significantly associated with fewer visits to the PHN at school. Girls reported lower HRQoL and mental health, and more pain and frequent OTCA use than boys. When having symptoms of psychological distress, boys had greater odds of visiting the PHN at school than girls. For girls in senior high school, headaches and OTCA use were strongly associated with visiting the PHN at school and the YHC. In senior high school, boys with an immigration background had greater odds of visiting the YHC than native Norwegian boys, while girls with an immigration background were less likely to visit the YHC than native Norwegian girls.

CONCLUSIONS

Our results show that more girls than boys use youth healthcare services. When adolescents experience pain, have mental problems, use OTCA, or report low levels of HRQoL, they have greater odds of using youth healthcare services. Youth healthcare services offer excellent opportunities to support and follow up with adolescents. The findings provide important insights into youth healthcare services used by adolescents for various stakeholders, including PHNs and policy makers, with potential implications for future public health efforts.

Depression and dissociation mediate the association between bullying victimization and self-cutting

BACKGROUND

Bullying victimization is experienced by more than 10% of children and adolescents worldwide and has been associated with numerous negative mental health consequences, such as depression and dissociation.

AIMS

We investigated the association between bullying victimization and self-cutting in a Finnish adolescent population and whether depression and dissociation act as mediators in this association.

METHODS

We used cross-sectional questionnaire data from Finnish students (age 13-18; N = 3345; boys n = 1454; girls n = 1891). Logistic regression and mediation analyses were performed.

RESULTS

Bullying victimized adolescents were younger, more likely to be afraid to go to school, had fewer friends, felt lonelier, and had a poorer relationship with family members, as well as higher level of depressive and dissociative symptoms compared to non-bullied adolescents. According to logistic regression analysis, the association between bullying and self-cutting remained significant despite all other adjustments besides those for depressive symptoms. In serial mediation analysis, depressive and dissociative symptoms mediated the effect of bullying victimization on self-cutting, regardless of their order in the model.

CONCLUSIONS

Self-cutting is more common among bullying victimized adolescents than their peers. The association is mediated by depressive and dissociative symptoms. More studies are needed to clarify the exact mechanisms via which depressive and dissociative symptoms interact with the association between bullying and self-harm.

Facilitating factors for seeking help for mental health problems among Norwegian adolescent males: A focus group interview study

BACKGROUND

Young males are overrepresented in suicide statistics and underrepresented in statistics of help-seeking and receiving help from formal health services compared with young females. Few studies have examined facilitating factors for help-seeking among adolescent males with no previous experience seeking mental health help. This study aimed to explore thoughts, attitudes, and experiences regarding facilitating factors toward formal help-seeking for mental health problems among Norwegian adolescent males.

METHOD

Three focus group interviews were conducted, each including four adolescent males with no experience with help-seeking or receiving help from a help service for mental health problems. The interviews addressed topics such as barriers and facilitating factors for help-seeking and preferences regarding structural factors and modes of delivery of help. Data were analyzed according to the systematic text condensation method.

RESULTS

The analysis revealed three main categories of facilitating factors: (1) transparent information and available help services, (2) proactive and outreaching help services, and (3) the possibility for discreet help-seeking.

CONCLUSIONS

Improving help-seeking is integral to accessing care and improving mental health. Help services can be more accessible and approachable for male adolescents if they offer discretion, the possibility to remain anonymous, the option to receive help in a convenient context, and outreach services.

Demand for health services or professionals among adolescents: a multilevel study

This study aimed to analyze the demand for health services or professionals by adolescents with individual determinants and contextual variables (school teaching modality and Social Vulnerability Index). Data were collected from March to June 2018, in state public schools in Olinda, Pernambuco, Brazil, through a structured questionnaire with questions from the Youth Risk Behavior Survey (YRBS) and the National School Health Survey (PeNSE). Among the 2,454 adolescents, the proportion of those looking for a health service was higher among women; in adolescents whose mothers had a minimum of nine schooling years; in the physically active; and whose parents did not receive a family aid (Bolsa Família). We observed that the contextual variables did not influence the demand for health services among adolescents. In the third model of the multilevel analysis, which analyzed the individual variables, we observed that only females (OR=1,80), having a mother with schooling greater than or equal to 9 years of study (OR=1,30), not receiving Bolsa Família (OR=1,23), and physically active (OR=1,32) were associated with an increased demand for health services or professionals.

Stress, mental and physical health and the costs of health care in German high school students

Stress is a mind-body phenomenon, which affects both mental and physical health and is highly relevant to the health care system. Yet, knowledge on the costs of stress and related health problems in adolescence is missing. The present study addresses this gap by investigating direct health care costs in relation to stress, mental health problems and physical health in high school students. The sample comprised 284 pupils from four schools in Heidelberg (mean age 16.75 ± 0.64 years, 59.64% female). Self-reported health care utilization and medication intake within 1 month were translated into costs. We established correlative associations of the dichotomized overall costs (no vs. any) with stress, mental health problems and physical health within generalized structural equation models. In particular, mental health problems and physical health were examined as mediators of the association between stress and costs. An increase of stress by 1 SD corresponded increased chances for costs by OR 1.39 (Odds Ratio; 95% CI  0.13-0.53, p = 0.001). When mediators were analysed separately, both mental and physical health (problems) fully mediated the association. Yet, when examined together, only mental health problems acted as a mediator. Our results indicate the health economic relevance of stress-related mental health problems in high school students. The finding is meant to set the stage for further cost-of-illness studies of stress and related health problems, as well as economic evaluations. Longitudinal research is needed to allow conclusions on directionality.

The meaning of seasonal changes, nature, and animals for adolescent girls' wellbeing in northern Finland: A qualitative descriptive study

Wellbeing is complex, holistic, and subjectively perceived. Issues such as gender, age, and environment seem to affect it. Therefore, the aim of this qualitative study was to describe the meaning of seasonal changes, nature, and animals towards 13-16-year-old girls' wellbeing in Northern Finland. In the spring of 2014, through purposive sampling, a total of 19 girls participated in semi-structured interviews from various parts of Northern Finland. The data were analysed using content analysis. Afterwards, the analysis combining the category participatory involvement with environment was found, and this consisted of three main categories: adaptation to seasonal changes, restorative nature, and empowering interactivity with animals. Seasonal changes had an effect on girls' wellbeing; in the summertime, they felt happy and vivacious, active, and outgoing. Instead, during the winter months, girls' mood and activity seemed to be lower and they felt lazier and depressed. Nature brought mainly positive feelings to girls; being in nature was experienced as liberating and relaxing, and it offered opportunities to relax and have sensory perceptions. Interaction with animals was perceived as empowering. They were experienced as altruistic and comforting companions. Animals were important to girls, and they contributed to girls' lives through positive effects towards their mental and physical wellbeing. Based on the results of this study, we can recommend that being in nature and interacting with animals should be supported because they seem to have benefits towards adolescent girls' health and wellbeing. In order to facilitate the negative effects of winter, the school days should be arranged in such a way that it would be possible for girls to have outdoor activities during the daytime. The challenge for the future is perhaps the purposeful utilisation of nature's and the animals' positive effects towards their wellbeing.

Adolescent school absenteeism and service use in a population-based study

BACKGROUND

School absenteeism is linked to a range of health concerns, health risk behaviors and school dropout. It is therefore important to evaluate the extent to which adolescents with absenteeism are in contact with health care and other services. The aim of the current study was to investigate service use of Norwegian adolescents with moderate and high absenteeism in comparison to students with lower rates of absence.

METHODS

The study employs data from a population-based study from 2012 targeting all pupils in upper secondary education in Hordaland County, Norway (the youth@hordaland-survey). A total of 8988 adolescents between the ages of 16 and 18 were included in the present study. Information on service use was based on adolescent self-report data collected in the youth@hordaland-survey. Absence data was collected using administrative data provided by the Hordaland County Council.

RESULTS

High absence (defined as being absent 15% or more the past semester) was found among 10.1% of the adolescents. Compared to their peers with low absence (less than 3% absence the past semester), adolescents with high absence were more likely to be in contact with all the services studied, including mental health services (odds ratio (OR) 3.96), adolescent health clinics (OR 2.11) and their general practitioner (GP) (OR 1.94). Frequency of contact was higher among adolescents with moderate and high absence and there seems to be a gradient of service use corresponding to the level of absence. Still, 40% of the adolescents with high absence had not been in contact with any services.

CONCLUSIONS

Adolescents with high absence had increased use of services, although a group of youth at risk seems to be without such contact. This finding suggests a potential to address school absenteeism through systematic collaboration between schools and health personnel.

Accumulation of psychosocial and lifestyle factors and risk of low back pain in adolescence: a cohort study

PURPOSE

Low back pain (LBP) is common already in adolescence, and many risk indicators including both psychosocial and lifestyle factors have been recognized. Our purpose was to assess whether the co-occurrence of psychosocial (externalizing and internalizing) problems and lifestyle factors (leisure time physical activity, sedentary behaviour, sleep, smoking, and overweight/obesity) associate with LBP at 16 years cross-sectionally or with new LBP at 18-year follow-up.

METHODS

The study population, drawn from the Northern Finland Birth Cohort 1986, consisted of 1625 participants (712 boys and 913 girls) who completed a questionnaire on potential explanatory factors at 16 years and on LBP at 16 and 18 years. The outcome measure was 'reporting LBP' or 'consultation for LBP' during the past 6 months. Latent Class Analysis (LCA) was utilized to study the co-occurrence of the explanatory factors.

RESULTS

Among both genders, four clusters were found. Externalizing behaviour problems were associated with 'reporting LBP' (RR 1.5, boys 1.4, girls) and 'consultation for LBP' (RR 1.6 for both genders) at baseline among both genders. In addition, the cluster of multiple risk behaviours was associated with both 'reporting LBP' (RR 1.3) and 'consultation for LBP' (RR 2.5) and the obese cluster with 'consultation for LBP' (RR 1.7) among girls. Externalizing behaviour problems at 16 years predicted 'consultation for LBP' at 18 years among girls (RR 3.6).

CONCLUSIONS

Our results stress the role of psychosocial factors in reporting and seeking care for adolescent LBP.