Temporal trends in psychological distress and healthcare utilization among young people

Abstract

Background: Young people are generally considered to be healthy, as severe illness and mortality is uncommon during this developmental stage. However, there are increasing concerns that psychological distress may be increasing in recent generations of youth, which will generate greater healthcare needs. Overall aims: The overall aims of this thesis were to investigate the temporal trends of psychological distress (also referred to as psychosomatic health complaints) among the general youth population and to investigate the association between the utilization of the youth primary healthcare service and psychological distress. Material and methods: The first paper used the Joanna Briggs Institute framework to conduct a systematic review and meta-analysis of prevalence studies, systematically identifying, selecting and critically appraising all the global evidence on psychosomatic health complaints among young people. The primary databases searched were MEDLINE, Embase and PsycINFO. Studies were included if they were of a repeated cross-sectional design and contained the self-reported data of 1019-year-olds. Inclusion criteria and study quality were assessed by two independent reviewers. The second paper was a repeated cross-sectional study investigating temporal trends of psychosomatic health complaints among 11-16-year-olds in Norway between 1994 and 2014. The data were drawn from the Norwegian HBSC study (n = 27,476). The third paper was a repeated cross-sectional study investigating the temporal trends of psychological distress and its relationship to youth primary healthcare utilization among 13-19-year-olds in Norway, between 2014 and 2018 (n = 368,579). The data were drawn from the Norwegian “Ungdata” study. Results: Paper I: The systematic search of the literature yielded 8,338 potentially relevant articles. Twenty-one studies met the inclusion criteria and were included in the study. In total, this study represents over seven million young respondents from 36 countries, mainly in Europe and North America, covering the time period between 1982 and 2013. Overall, the results indicated a minor increasing trend of psychosomatic health complaints among young people. However, the increase was mainly found in Northern Europe, while other geographical regions had more stable trends. Paper II: In Norway, psychosomatic health complaints increased between 1994 and 2014 among young people. There were indications that psychological and somatic health complaints might follow different trajectories. For psychological health complaints, there was a three-way interaction between age, gender and time, indicating that older teenage girls experience a greater increase in psychosomatic health complaints over time relative to boys and younger adolescent girls. In terms of somatic health complaints, older teenage girls also had the greatest increase over time, but this difference was constant and did not diverge from the other groups over time. Paper III: Psychological distress and primary healthcare utilization increased between 2014 and 2018 among young people in Norway. Psychological distress was associated with primary healthcare utilization, and young people with high levels of psychological distress used services twice as often as their peers. Psychological distress could account for a substantial amount of the change in utilization of youth primary healthcare. However, the absolute increase in primary healthcare utilization was mainly driven by those with low levels of psychological distress, as opposed to young people with high levels of distress. This suggests that primary healthcare utilization among young people with high and low levels of distress is converging, which could indicate overuse among less distressed youths and underuse among more distressed youth. Conclusion and implications for practice: The prevalence of psychological distress (psychosomatic health complaints) among young people from 36 different countries in Europe and North America appeared to remain stable in large parts of Europe and North America between 1980 and 2013. However, Northern Europe stood out in terms of displaying an increasing trend of psychological distress among young people, suggesting that increasing psychological distress among this age group is primarily a Northern European phenomenon. In Norway, psychological distress among young people appear to have been systematically increasing between 1994 and 2018, especially among older teenage girls. Furthermore, since psychological distress is associated with primary healthcare utilization, one would expect that part of the increase could be explained by a growing population of psychologically distressed young people. However, this does not appear to be the case, as the greatest increase identified in the utilization of youth primary healthcare, occurs primarily among the less distressed. This raises questions about the expected need for healthcare and actual healthcare utilization, on the pathways from distress to care and the effectiveness of youth primary healthcare. School-based interventions tailored to reduce psychological distress symptoms or psychosomatic health complaints should be tailored to address the needs of older teenage girls, who tend to be more distressed. Intervention strategies should also be developed to improve health literacy among young people to enable them to identify and seek help for psychological distress.