The nature of subjective health complaints in adolescence: Dimensionality, stability, and psychosocial predictors
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Despite the fact that adolescence is regarded as a period in life with good health and where severe illness is uncommon, many adolescents struggle with different kinds of health complaints in their daily lives. From a preventive point of view it is crucial to gain insight into the nature of health complaints among children and adolescents, as well as their aetiology. The main purpose of the present thesis is to provide knowledge about the underlying structures in health complaints, the stability and development of health complaints, and the reciprocal relationship between psychosocial predictors in the school context and subjective health complaints in adolescence. Possible implications for the development of preventive efforts are also addressed. The thesis consists of three papers, and the papers apply data from three different studies. Paper one is based on data from two of the studies. First, a sub-sample, consisting of 1251 Norwegian students (11 -15 year olds) from the Health Promoting Schools study (ENHPS) was used. Second, data from a nation wide study amongst 7059 Norwegian students (aged 11, 13, 15, and 16) from the Health Behaviour in School-aged Children (HBSC) study was used. In paper two, panel data from the Norwegian Longitudinal Health Behaviour (NLHB) study (n = 891) was applied. Finally, in paper three, a cohort of 386 students in Grade 8 (aged 13) from the ENHPS study was used. Analyses were mainly conducted within the Structural Equation Modeling (SEM) framework using AMOS 4.01 and 5.0. The results of the present thesis give no clear answer to the question of dimensionality underlying subjective health complaints. However, the findings in paper one suggest that there may be two underlying dimensions in subjective health complaints that may be labelled “somatic” and psychological” complaints, and that the two dimensions are highly correlated. All three papers in the thesis address developmental trends in subjective health complaints. While there is consistent evidence of an increase in complaints from early to mid adolescence among girls, the developmental trend is less pronounced among boys. Furthermore, the results from paper one and two indicate that differences in the developmental patterns between boys and girls result in an emergence of a gender difference that persists throughout adolescence. There is also evidence of a substantial relative stability in subjective health complaints during adolescence, reported in paper two, and an indication of an increasing relative stability with age. Finally, there is some evidence of a relationship between being bullied over time and a steeper developmental increase in subjective health complaints in paper three. Furthermore, social support from teachers and students is to some extent related to lower levels of complaints, while there is a clear relationship between support from fellow students and lower levels of being bullied across time. The findings in the present thesis confirm that the patterns of subjective health complaints may have developed already by adolescence and that there is considerable stability in such complaints. Consequently, interventions in adolescence may also have an impact on the prevalence of complaints later in life. Furthermore, findings from the present thesis indicate that psychosocial predictors, like being a victim of bullying and social support in the school context, may be important target factors for interventions aimed at promoting psychosocial aspects of health.
Består avPaper I: Scandinavian Journal of Public Health 30(3), Hetland, J.; Torsheim, T. & Aarø, L. E. (2002), Subjective health complaints in adolescence: Dimensional structure and variation across gender and age, pp. 223-230. Copyright 2002 Taylor & Francis. Reproduced with permission. Published version available at: http://dx.doi.org/10.1080/140349402320290953
Paper II: Hetland, J.; Aarø, L. E.; Torsheim, T. & Wold, B., Stability and change in subjective health complaints from adolescence to early adulthood. Draft. Full text not available in BORA.
Paper III: Hetland, J.; Freeman J. & Samdal, O. Subjective health complaints and bullying in early adolescence: A longitudinal study. Draft. Full text not available in BORA.