Are social pressure, bullying and low social support associated with depressive symptoms, self-harm and self-directed violence among adolescents? A cross-sectional study using a structural equation modeling approach.

BACKGROUND: More in-depth evidence about the complex relationships between different risk factors and mental health among adolescents has been warranted. Thus, the aim of the study was to examine the direct and indirect effects of experiencing social pressure, bullying, and low social support on mental health problems in adolescence. METHODS: A school-based cross-sectional study was conducted in 2022 among 15 823 Norwegian adolescents, aged 13-19 years. Structural Equation Modelling was used to assess the relationships between socioeconomic status, social pressure, bullying, social support, depressive symptoms, self-harm and suicide thoughts. RESULTS: Poor family economy and low parental education were associated with high pressure, low parental support and depressive symptoms in males and females. Moreover, poor family economy was associated with bullying perpetration and bullying victimization among males and females, and cyberbullying victimization among females, but not males. Low parental education was associated with bullying victimization among males, but not females. Further, high social pressure was associated with depressive symptoms among males and females, whereas high social pressure was linked to self-harm and suicide thoughts among females, but not males. Bullying victimization and cyberbullying victimization were associated with depressive symptoms, self-harm, and suicide thoughts among males and females. Bullying victimization was associated with depressive symptoms among males, but not females, whereas bullying perpetration was linked to self-harm and suicide thoughts among females, but not males. Low parental support was associated with bullying perpetration, bullying victimization, depressive symptoms, self-harm and suicide thoughts among males and females, whereas low parental support was associated with high social pressure among females, but not males. Low teacher support was associated with high social pressure and depressive symptoms. Low support from friends was associated with bullying victimization, depressive symptoms and suicide thoughts among males and females, whereas low support from friends was linked to self-harm among males, but not females. Finally, results showed that depressive symptoms were associated with self-harm and suicide thoughts among males and females. CONCLUSION: Low socioeconomic status, social pressure, bullying and low social support were directly and indirectly associated with depressive symptoms and self-directed violence among Norwegian adolescents.

Changes in health-related quality of life and sleep habits after a 6-month non-randomised cluster-controlled trial among children with overweight or obesity.

Being overweight or obese can have severe negative psychological impacts and reduce health-related functioning. To improve health-related quality of life (HRQoL) and sleep habits for children with overweight or obesity, it is important to design and implement effective interventions. The aim of this study was to evaluate the effects of a 6-month family-based lifestyle intervention on HRQoL and sleep habits in Norwegian children with overweight or obesity in a primary-care setting. This 6-month, non-randomised, cluster-controlled trial included Norwegian children aged 5-13 years with overweight or obesity and their parents. A questionnaire was filled out by the parents. A total of 33 and 52 children in the control group and 41 and 78 children in the intervention group answered the HRQoL and sleep habits questions, respectively, and were included. The intervention group received individual family counselling and participated in physical activity groups and nutrition courses. The Children's Sleep Habits Questionnaire (CSHQ) and Kidscreen-10 index were used to assess sleep habits and HRQoL. At baseline, the mean average scores for HRQoL were 50.0 [standard deviation (SD) 8.1] for the intervention group and 49.0 (SD 10.1) for the control group. For sleep habits at baseline, the mean average scores were 45.2 (SD 11.8) for the intervention group and 46.0 (SD 11.9) for the control group. No significant changes in HRQoL and sleep habits after the intervention were revealed. Overall, the family-based lifestyle intervention targeting overweight and obese children in a primary-care setting showed no significant effect on HRQoL or sleep quality.

Time trends in self-reported depressive symptoms, prescription of antidepressants, sedatives and hypnotics and the emergence of social media among Norwegian adolescents.

BACKGROUND: Research has shown increased mental health problems and use of prescription drugs among adolescents in recent years and social media use has been linked to poorer mental health. However, trend studies concerning these topics are scarce. The purpose of this study was to analyze gender-specific trends in a) symptoms of depression and loneliness, and b) prescription of antidepressants, hypnotics and sedatives, in relation to the emergence of social media among adolescents in Norway. METHODS: This is an ecological study using data from the 'Young in Oslo' surveys from 1996 to 2021. The surveys included approximately 110 000 students, 14-17 years of age, and yielded a response rate varying from 95% in 1996 to 64% in 2021. A self-report questionnaire was used to collect information on symptoms of depression and loneliness. Information on antidepressant and sleep medication prescription was retrieved from the Norwegian Prescription Database for the age group 15 to 19 years. A graphical approach and logistic regression models were used to examine gender-specific time-trends between 1996 to 2021. RESULTS: We found a doubling in self-reported symptoms of depression and loneliness among girls between 1996 and 2021, with the steepest increase in the period from 2006 to 2012, when Facebook and other social media were introduced. A similar trend was observed in the prescription of antidepressants among girls, with the steepest increase between 2011 and 2013. Among both boys and girls, 'worried too much about things' and 'had sleep problems' were the two symptoms with the greatest changes. CONCLUSION: A significant upward trend in self-reported depressive symptoms and medication use was observed over the past 25 years, with variations in the rate of increase, including a steeper trajectory during certain periods immediately after the introduction of social media platforms in Norway.

Explaining variance in self-efficacy among adolescents: the association between mastery experiences, social support, and self-efficacy.

BACKGROUND: Self-efficacy has been identified as an important health-promoting factor for both physical and mental health. Previous studies have examined self-efficacy as a moderating factor between negative psychosocial influences and various outcomes, e.g., life satisfaction and stressors. There is, however, limited knowledge about factors that strengthen self-efficacy. The aim of this study is to examine the association between mastery experiences, social support, and self-efficacy among adolescents in secondary schools in Norway. METHODS: This study is based on cross-sectional data from the Ungdata surveys conducted in eastern part of Norway in 2021. The sample comprises 9,221 adolescents aged 13-16. Sequential multivariate linear regression was conducted to explore the association between mastery experiences, social support, and self-efficacy. RESULTS: The final model (Model 3) explains 25% of the total variance in self-efficacy. The indicators concerning mastery experiences - defined here as the personal experience of success - explain more of the observed variance in self-efficacy than the other independent variables (change in R square = 10.7%). The items 'felt mastering things' 'and 'felt useful' make the strongest and most significant contributions to the variance in self-efficacy in the final model (ß = 0.25, p < 0.001 and ß = 0.16, p < 0.001, respectively), followed by the variables 'support from friends' and 'parental support' (ß = 0.06, p < 0.001 an ß = 0.06, p < 0.001). CONCLUSIONS: Mastery experiences are potential sources for creating and strengthening self-efficacy. Awareness of the health-promoting potential in (strengthening) self-efficacy among adolescents is important. Additional research is needed to further explore these associations.

Patterns of unhealthy behaviours during adolescence and subsequent anxiety and depression in adulthood: a prospective register linkage study of the HUNT survey and health registries.

BACKGROUND: There is increasing need for prospective investigations in the preventing role of health-related behaviours on mental health problems. The aim of this study is to identify patterns of health-related behaviours in adolescence, and the association between the behavioural patterns and the subsequent diagnoses and/or drug treatment for anxiety and/or depression in adulthood. METHODS: This prospective study consisted of 13-19-year-old participants in the Trøndelag Health Study (Young-HUNT3) in 2006-2008 (n = 2061, 1205 females and 856 males) in Norway, who also participated in HUNT4 (2017-2019). Survey data on health-related behaviours in adolescence, including low level of physical activity, low consumption of wholegrain bread, fish, fruit, vegetables and high consumption of sugar-sweetened beverages and insomnia were linked on an individual level to prospective information on drug use and diagnosis in national health registries. The different patterns of health-related behaviours were identified through latent class analysis. Subsequent anxiety or depression was defined as at least one recording in either of three registries covering recorded diagnosis in primary and specialist healthcare, or dispensed prescription drugs during 2008-2019. Additionally, self-reported psychological distress measured in young adulthood was applied as a supplemental outcome measure. RESULTS: Four patterns of health-related behaviours were identified: high risk behaviours (class 1), moderate to high risk behaviours (class 2), low to moderate risk behaviours (class 3) and low risk behaviours (class 4). Adolescents in class 3 showed higher odds of subsequent diagnoses for anxiety and/or depression in primary and specialist healthcare compared to class 4 participants. In addition, both class 1 and class 4 participants had higher odds for self-reported psychological distress than those class 4 (OR = 1.56 and OR = 1.86, respectively). CONCLUSIONS: Our findings suggest that health-related behaviours are clustered among Norwegian adolescents. The patterns of unhealthy behaviours during adolescence only partly increased the risk of anxiety and depression in adulthood. Promoting healthy behaviours during adolescence may potentially reduce the burden of mental illness in adulthood, but further research is needed to clarify the nature of the relationships.

Leisure-Time Activities in Different Contexts and Depressive Symptoms in Norwegian Adolescents: A Cross-Sectional Study.

The purpose of this study was to examine the association between physical activity organised in sports clubs, non-organised physical activity, other organised leisure-time activities, and depressive symptoms among adolescents. This study was based on cross-sectional data from the Ungdata survey conducted between 2017 and 2019. The sample comprised 7656 adolescents (aged 13-16 years). Binominal logistic regression was used to analyse the association between the three different leisure-time activities and depressive symptoms. All models were adjusted for gender, family economy, parents' higher education, having friends, alcohol intoxication, and smoking. The odds for symptoms of depression were higher for those who were less physically active in a sports club (OR: 1.34, 95% CI: 1.15-1.57) and in non-organised physical activities (OR: 1.50, 95% CI: 1.29-1.74) and lower for those who participated less in other organised leisure-time activities (OR: 0.79, 95% CI: 0.68-0.92) compared with those who were physically active (sports club and non-organised) and those who participated in other organised leisure-time activities. Our findings suggested that being physically active, both in a sports club and in non-organised activities, was associated with lower odds of depressive symptoms among adolescents. Additional research is needed to confirm a possible causal relationship.

Using Rasch Analysis to Assess the Psychometric Properties of a Five-Item Version of the General Self-Efficacy Scale in Adolescents.

The aim of the present study was to use Rasch analysis to assess the psychometric properties of the five-item version of the General Self-Efficacy Scale (GSES) amongst adolescents aged 13 to 19. In this cross-sectional study, 6265 adolescents responded to a web-based questionnaire. Data collected from lower and upper secondary schools in Norway, during 2018, were analysed using the partial credit parameterisation of the unidimensional Rasch model. The five-item version of the GSES was found to be unidimensional and to have acceptable reliability. The targeting of the scale could have been better. All items had ordered thresholds, indicating that the response categories worked quite well. The five-item version of the GSES has potential for measuring self-efficacy in a general population of adolescents. In surveys concerning adolescents' mental health, it is important to include aspects of positive mental health and health-promoting factors, such as self-efficacy.

Association between physical activity, sedentary time, participation in organized activities, social support, sleep problems and mental distress among adults in Southern Norway: a cross-sectional study among 28,047 adults from the general population.

BACKGROUND: Identification of modifiable factors associated with poor mental health is crucial to develop targeted and effective intervention strategies for prevention of mental distress and illness in the general population. Thus, the aim of the present study was to examine the association between low level of leisure-time physical activity, high sedentary time, low participation in organized activities, low social support, sleep problems, and mental distress in a large sample of Norwegian adults. METHODS: A cross-sectional study was completed by 28,047 adults (≥18 years old) in southern Norway by filling out an online self-report questionnaire. Multivariable binary logistic regression models, stratified according to gender and adjusted for age and perceived financial situation, were used to examine possible associations between unhealthy lifestyle behaviors, participation in organized activities, social support, and mental distress. RESULTS: Our results showed an increased odds of having mental distress among men reporting low leisure-time physical activity (OR: 1.18; 95%CI: 1.03-1.37), high sedentary time (1.32; 1.16-1.51), low involvement in organized activities (1.43; 1.25-1.64), low social support (2.55; 2.18-2.99), and sleep problems (7.29; 6.35-8.37) compared to the rest of the male population. For women, the results showed increased odds of mental distress among those reporting high sedentary time (1.25; 1.11-1.39), low involvement in organized activities (1.60; 1.42-1.80), low social support (2.71; 2.39-3.06), and sleep problems (5.78; 5.15-6.50) compared to the rest of the female population. For both men and women, results also indicated that mental distress was increased among younger adults and among those reporting financial difficulties compared to the rest of the population. CONCLUSION: Our results showed an association between unhealthy lifestyle behaviors, low participation in organized activities, low social support and mental distress, and that the strength of the association varied substantially. These findings provide increased knowledge about the relationship between modifiable lifestyle factors and mental health which should have implications for future public health efforts.

Association between Self-Reported Childhood Difficulties and Obesity and Health-Related Behaviors in Adulthood-A Cross-Sectional Study among 28,047 Adults from the General Population.

The aim of the present study was to examine the associations between self-reported childhood difficulties, weight status, and lifestyle behaviors among a representative sample of Norwegian adults. This cross-sectional study included 28,047 adults (>18 years old) living in southern Norway. A self-report questionnaire was used to assess information about the overall quality of the respondents' childhood retrospectively in addition to current weight status and current lifestyle behaviors. Multivariable logistic regression models adjusted for gender, age, and educational level showed that evaluating childhood as difficult was associated with increased odds of obesity (OR: 1.29; 95% CI; 1.16-1.44) in adulthood. Moreover, a difficult childhood was associated with increased odds of unhealthy lifestyle behaviors in adulthood, including low consumption of fruit and berries (1.21; 1.09-1.34) and fish (1.43; 1.30-1.57), high consumption of sugar-sweetened beverages (1.30; 1.14-1.48), low level of physical activity (1.10; 1.01-1.21), smoking cigarettes (1.78; 1.61-1.97), and using smokeless tobacco (1.20; 1.07-1.36). Overall, results from the present study suggest that experiencing childhood as difficult is associated with an increased risk of obesity and a range of unhealthy lifestyle behaviors in adulthood. Thus, our findings highlight the importance of identifying and providing support to children in difficult life circumstances in addition to customized and targeted public health efforts in adulthood.

Negative social media-related experiences and lower general self-efficacy are associated with depressive symptoms in adolescents.

Social media are an integral part of adolescents' daily lives, and reviews have suggested an overall small association between more social media use and mental health problems. However, researchers have commonly investigated social media use in a time use perspective, rendering nuances in adolescents' social media experience less well explored. Thus, studies of relationships between social media use and mental health problems need also examine the nature of the events taking place on social media. This study aimed to examine depressive symptoms in adolescents in relationship to time spent on social media, negative social media-related experiences, and general self-efficacy. Data collected in a national survey, Ungdata 2021 (n = 139,841), was used. Multivariate linear regression analyses showed that time spent on social media was associated with depressive symptoms (ß = 0.09, p < 0.001). However, negative social media-related experiences were more strongly associated with depressive symptoms (ß ranging 0.09-0.22, all p < 0.001), and their inclusion weakened the initial association between time on social media and depressive symptoms. General self-efficacy was directly associated with lower symptom levels (ß = -0.29, p < 0.001) but did not change the associations between social media use and depressive symptoms. The findings imply that not only time spent on social media, but in particular negative social media-related experiences, are related to depressive symptoms in Norwegian adolescents. General self-efficacy is an important resource for adolescents' mental health.

Physical activity, sugar-sweetened beverages, whole grain bread and insomnia among adolescents and psychological distress in adulthood: prospective data from the population-based HUNT study.

BACKGROUND: In this study, we examined the relationship between low levels of physical activity, high consumption of sugar-sweetened beverages and low consumption of whole grain bread and experiencing insomnia in adolescence and psychological distress in young adults. METHODS: This prospective study was based on information retrieved from the Trøndelag Health Study (HUNT) in Norway and included adolescents (age 13-19) participating in Young-HUNT3 (2006-2008) and in HUNT4 (2017-2019) 11 years later (age 23-31). The study sample consisted of 2,230 participants (1,287 females and 943 males). The exposure variables collected in adolescence included self-reported physical activity, consumption of sugar-sweetened beverages and whole grain bread and insomnia, and psychological distress in young adulthood was used as an outcome variable. The relationship between lifestyle behaviours in adolescence and psychological distress in young adulthood was examined using multivariable logistic regression, adjusted for gender, age and psychological distress in adolescence and educational level in young adulthood. RESULTS: An increased odds of psychological distress was shown among young adults who reported low levels of physical activity (OR: 1.44, 95 % CI: 1.10-2.89), high consumption of sugar-sweetened beverages (OR: 1.49, 95 % CI: 1.12-1.98), low consumption of whole grain bread (OR: 1.35, 95 % CI: 1.04-1.77) and insomnia (OR: 1.69, 95 % CI: 1.23-2.33) in adolescence. In terms of absolute differences, unhealthy lifestyle behaviours increased the risk of psychological distress in young adulthood between 3.18 (95 % CI: 0.29-6.07) (low whole grain bread consumption) and 6.01 (95 % CI: 1.95-10.07) (insomnia) percentage points. CONCLUSIONS: Low levels of physical activity, high consumption of sugar-sweetened beverages and low consumption of whole grain bread and insomnia during adolescence were associated with psychological distress in young adulthood.

Using the Rasch measurement theory to assess the psychometric properties of the Hopkins Symptom Checklist-10 in adolescents.

BACKGROUND: The Hopkins Symptom Checklist-10 (HSCL-10) is widely used to measure psychological distress in adolescents. To provide valid and reliable results and generate recommendations for practice and policies, instruments with sound psychometric properties are required. The purpose of this study is to use Rasch measurement theory to assess the psychometric properties of the HSCL-10 among adolescents aged 13-19. METHODS: In this cross-sectional study, 6445 adolescents responded to a web-based questionnaire. Data were collected from lower and upper secondary schools in Norway during 2018. The data were analysed using the partial credit parameterisation of the unidimensional Rasch model. RESULTS: HSCL-10 was found to be unidimensional and to have acceptable reliability. One pair of items showed response dependency. The targeting of the instrument could have been better. All items had ordered thresholds. Three items under-discriminated and three displayed differential item functioning regarding gender. CONCLUSIONS: HSCL-10 has potential for measuring psychological distress in adolescents, though there is room for improvement. To further improve this instrument, some items should be rephrased.

The Association between Dietary Habits, Substance Use, and Mental Distress among Adults in Southern Norway: A Cross-Sectional Study among 28,047 Adults from the General Population.

The aim of the present study was to examine associations between dietary habits, substance use, and mental distress among adults. This cross-sectional study was conducted in 2019 using an online questionnaire and included 28,047 adults (≥18 years) from Southern Norway. Multivariable logistic regression models stratified by gender were used to examine the associations between different lifestyle behaviors and mental distress. The results showed increased odds of mental distress among males and females with low consumption of vegetables (OR:1.26; 95% CI:1.08-1.47 and 1.14; 1.02-1.28) and fish (1.28; 1.12-1.46 and 1.36; 1.22-1.52), and among females, but not males, with high consumption of sugar-sweetened beverages (1.25; 1.06-1.48) compared to those with a healthier consumption of these foods and beverages. The results also showed increased odds of mental distress among male and female smokers (1.38; 1.19-1.60 and 1.44; 1.26-1.64), and among females, but not males, reporting current use of smokeless tobacco (1.20; 1.03-1.40), compared to male and female non-smokers and female non-users of smokeless tobacco. Overall, unhealthy dietary habits, smoking and the use of smokeless tobacco was associated with increased odds of mental distress, but the relationship varied according to gender. Future studies are needed to confirm any possible causal relationships.

Electronic media use and symptoms of depression among adolescents in Norway.

BACKGROUND: The purpose of this study was to examine the association between electronic media use, including use of social media and gaming, and symptoms of depression, and whether gender or having friends moderated these associations. METHODS: This study was based on self-reported cross-sectional data from the Ungdata survey, conducted in 2018 by the Norwegian Social Research (NOVA) Institute in cooperation with seven regional drug and alcohol competence centres. The target group comprised 12,353 15-16 years old adolescents. Binominal logistic regression was used to analyse the association between electronic media use and symptoms of depression. RESULTS: The odds of having symptoms of depression were higher for those who used social media more than 3 hours per day (OR: 1.60, 95% CI: 1.43-1.80), compared to those who used social media 3 hours or less per day. Additionally, the odds of having symptoms of depression was higher for those who used more than 3 hours on gaming per day (OR: 1.57, 95% CI: 1.36-1.80), compared to those who used 3 hours and less on gaming per day after adjustment for potential confounders. There were no interaction effects between social media and gaming use with symptoms of depression. Neither were the associations between social media use and gaming with symptoms of depression moderated by gender or having friends. CONCLUSIONS: The odds of having symptoms of depression were significantly higher for adolescents with a more frequent use of electronic media.

The association between screen time and reported depressive symptoms among adolescents in Sweden.

BACKGROUND: How screen use is associated with adolescents' mental health has been widely debated in public media during the last decade, but there is still lack of information about if and how the associations vary between types of electronic media. OBJECTIVE: This study aimed to examine how time spent on types of screen use (social media, gaming alone, gaming in groups and watching TV) was associated with depressive symptoms among adolescents in Sweden, and whether gender moderated these associations. METHODS: We analysed data from the Swedish section of the Children of Immigrants: Longitudinal Survey in Four European Countries. The final sample consisted of 3556 eighth grade adolescents in 2011 (51% girls). We used logistic regression analysis to estimate the odds ratio of feeling depressed often versus less often/not at all using time spent on different types of screen use as predictor variables. Additionally, we tested interaction effects between gender and the predictor variables. RESULTS: Our results showed that spending more than 2 hours on social media was associated with higher odds of feeling depressed often compared with spending 2 hours or less. Not watching TV was associated with higher odds of feeling depressed often compared with watching TV. These patterns did not differ across genders. Gaming alone and gaming in groups were not associated with depressive symptoms. CONCLUSIONS: Our findings suggest that more frequent social media use and not watching TV were associated with a higher level of depressive symptoms.

This study examined how time spent on four types of screen use including social media, gaming alone, gaming in groups and watching TV was associated with depressive symptoms among adolescents in Sweden, and whether these associations differed for girls and boys. We analysed data from the Swedish section of the Children of Immigrants: Longitudinal Survey in Four European Countries. The final sample consisted of 3556 eighth grade adolescents in 2011 (51% girls). We used logistic regression analysis to estimate the odds ratio of feeling depressed often versus less often/not at all using time spent on different types of screen use as predictor variables. In addition, we tested interaction effects between gender and the predictor variables. Our results showed that social media use and not watching TV was associated with higher odds of feeling depressed often. Gaming alone and gaming in groups were not associated with higher level of depressive symptoms. These patterns did not differ across genders.

Lifestyle habits and depressive symptoms in Norwegian adolescents: a national cross-sectional study.

BACKGROUND: This study's purpose was to examine the association between a broad range of lifestyle habits and depressive symptoms in Norwegian adolescents. METHODS: This study was based on national, self-reported, cross-sectional data from the Ungdata Surveys, conducted in 2017-2019. The target group comprised 244,250 adolescents (ages 13-19). Binominal logistic regression was used to analyse the association between lifestyle habits (physical activity, social media use, gaming, dietary habits, smoking, smokeless tobacco, alcohol intoxication) and depressive symptoms. The outcome measure was defined as a high level of depressive symptoms (≥80th percentile). Separate analyses were performed for boys and girls, and all models were adjusted for perceived family economy, parental higher education and age. RESULTS: The odds of having depressive symptoms were significantly lower among those who reported being physically active at least 3 times per week (OR; boys: 0.81, girls: 0.83), used social media ≤3 h per day (OR; boys: 0.65, girls: 0.70), engaged in gaming ≤3 h per day (OR; boys: 0.72, girls: 0.77), were non-smokers (OR; boys: 0.74, girls: 0.72) and had not experienced alcohol intoxication during the previous 12 months (OR; boys: 0.66, girls: 0.67). Furthermore, the results indicated a significant inverse association between depressive symptoms and high consumption of a range of healthy food items and low consumption of unhealthy food and beverages among girls. Similar tendencies were found among boys (OR; 0.77-0.91). Finally, higher adherence to healthy lifestyle habits was associated significantly with lower odds of having depressive symptoms among both genders (OR; boys: 0.40, girls: 0.52). CONCLUSIONS: A healthier lifestyle was associated with lower odds of having depressive symptoms. Additional research is needed to confirm a possible causal relationship.

Leisure time physical activity and depressive symptoms among adolescents in Sweden.

BACKGROUND: Mental health problems have increased noticeably among adolescents. Physical activity has been identified as an important factor in the promotion of mental health. The purpose of this study was to explore how leisure time physical activity was associated with depressive symptoms among adolescents in Sweden. METHODS: Using binary logistic regression we analyzed Swedish data collected as part of the Children of Immigrants: Longitudinal Survey in Four European Countries. The complete sample used for analysis consisted of 3787 adolescents (including 1855 boys and 1932 girls). RESULTS: Adolescents who participated in physical activity during their leisure time on a daily, weekly, or monthly basis had substantially lower odds of often feeling depressed than those who were physically inactive. This pattern applied to both boys and girls. Relative to boys, girls had significantly higher odds of often feeling depressed. CONCLUSIONS: The findings of this study suggested that participation in physical activity regularly during leisure time was associated with a lower level of depressive symptoms among adolescents in Sweden. Because of the cross-sectional study design conclusions about causality cannot be drawn. Future research based on longitudinal data is needed to further explore the mechanisms behind the association. This study calls for recognition of the value of physical activity in promoting mental health among adolescents.

Using Rasch measurement theory to assess the psychometric properties of a depressive symptoms scale in Norwegian adolescents.

BACKGROUND: Scales measuring depressive symptoms in adolescents and adults are widely used for epidemiological purposes. The purpose of this study is to use Rasch measurement theory to examine the psychometric properties of a six-item scale intended to measure depressive symptoms in Norwegian adolescents. METHODS: The study is based on cross-sectional data from Ungdata, a survey conducted by the Norwegian Social Research Institute in cooperation with Regional Centres for Drug Rehabilitation in 2017. The target group comprised 13- to 19-years olds in Norway. Six items with four response categories, intended to measure depressive symptoms, were analysed. The analysis focused on invariance, including differential item functioning across gender and school levels. In addition, targeting, possible multidimensionality, response dependency, and the categorisation of the items were analysed. RESULTS: The scale measuring depressive symptoms shows good reliability and, on the whole, the items work well. However, one item, 'had sleep problems', clearly misfit and another, 'worried too much about things', works differently for males and females. CONCLUSIONS: The scale has the potential to measure depressive symptoms in adolescents though there is room for improvement. To further improve the scale, the item concerning sleep problems should be rephrased.

Leisure-time physical activity among adolescents and subsequent use of antidepressant and hypnotic drugs: a prospective register linkage study.

In this prospective study, the association between physical activity and subsequent use of antidepressant and hypnotic drug use in adolescents aged 15-16 years was examined. This study is based on information retrieved from the Norwegian Youth Health Surveys (2000-2003) and linked to prescription data from the Norwegian Prescription Database (2004-2013). In total, the study included 10711 participants with a participation rate of 87%. Adolescents were asked how many hours per week they spent on physical activity that made them sweat and/or be out of breath outside of school. Incident psychotropic drug use (outcome measure) was defined as ≥ 1 prescription of one of the following psychotropic drugs: hypnotics and antidepressants registered in the Norwegian Prescription Database. In the crude model for the time period 2004-2007, the odds of incident hypnotic use were lower for those who were physically active 1-2 h per week (OR 0.48-0.64), compared to those who were physically inactive (< 1 h per week). However, the association become non-significant 4-year post-baseline (2008-2010 and 2011-2013). In the crude model for the time periods 2004-2007, 2008-2010 and 2011-2013, the odds of incident antidepressant use were lower for physically active adolescents (2004-2007: OR 0.46-0.71, 2008-2010: OR 0.40-0.67 and 2011-2013: OR 0.37-0.58, compared to those who were physically inactive < 1 h. However, after adjustment for confounders, the association became non-significant in all time periods except in physical activity 5-7 and 8-10 h in the period 2008-2010. Physical activity does not indicate any association with later use of antidepressants, and the significant association with incident hypnotic drug use was for short-term follow-up only and disappeared on longer term follow-up periods. Given the scarcity of longitudinal studies examining the association between physical activity and mental health as well as psychotropic drug use among young people, the current study adds to previous research.

Psychological distress among Norwegian adolescents: Changes between 2001 and 2009 and associations with leisure time physical activity and screen-based sedentary behaviour.

AIMS: The aim of this work was to examine psychological distress among Norwegian adolescents in relation to changes over time and the associations with leisure time physical activity and screen-based sedentary behaviour. METHODS: This cross-sectional study was based on data retrieved from the Norwegian Youth Health Surveys in 2001 and 2009 in Hedmark County. Adolescents aged 15-16 years old completed a questionnaire regarding physical activity, sedentary behaviour, psychological distress and other health and lifestyle variables. The self-report Hopkins Symptom Checklist-10 was used to assess psychological distress. Multinomial logistic regression was used to analyse the associations between psychological distress, physical activity and sedentary behaviour. RESULTS: Self-reported psychological distress increased significantly from 2001 to 2009 (from 19.4 to 28.2%), with the proportion of girls reporting psychological distress being twice as large as the proportion of boys. The proportion of adolescents who were physically active for ⩾11 hours per week increased significantly over the same period (from 6.0 to 10.4%). Sedentary behaviour ⩾6 hours per school day increased significantly among both sexes between 2001 and 2009. Physical activity (⩾11 hours) and sedentary behaviour (⩾6 hours) were both significantly associated with psychological distress. CONCLUSIONS: The association between physical activity, sedentary behaviour and psychological distress was weak; only high amounts of physical activity and high amounts of screen-based sedentary behaviour were associated with psychological distress. Longitudinal studies are needed to provide further insights into these associations and to understand the extent to which these variables might be causally related.