Item response theory and differential test functioning analysis of the HBSC-Symptom-Checklist across 46 countries.

BACKGROUND: The Symptom Checklist (SCL) developed by the Health Behaviour in School-aged Children (HBSC) study is a non-clinical measure of psychosomatic complaints (e.g., headache and feeling low) that has been used in numerous studies. Several studies have investigated the psychometric characteristics of this scale; however, some psychometric properties remain unclear, among them especially a) dimensionality, b) adequacy of the Graded Response Model (GRM), and c) measurement invariance across countries. METHODS: Data from 229,906 adolescents aged 11, 13 and 15 from 46 countries that participated in the 2018 HBSC survey were analyzed. Adolescents were selected using representative sampling and surveyed by questionnaire in the classroom. Dimensionality was investigated using exploratory graph analysis. In addition, we investigated whether the GRM provided an adequate description of the data. Reliability over the latent variable continuum and differential test functioning across countries were also examined. RESULTS: Exploratory graph analyses showed that SCL can be considered as one-dimensional in 16 countries. However, a comparison of the unidimensional with a post-hoc bifactor GRM showed that deviation from a hypothesized one-dimensional structure was negligible in most countries. Multigroup invariance analyses supported configural and metric invariance, but not scalar invariance across 32 countries. Alignment analysis showed non-invariance especially for the items irritability, feeling nervous/bad temper and feeling low. CONCLUSION: HBSC-SCL appears to represent a consistent and reliable unidimensional instrument across most countries. This bodes well for population health analyses that rely on this scale as an early indicator of mental health status.

Patterns of Health-Related Gender Inequalities-A Cluster Analysis of 45 Countries.

PURPOSE: The paper explores gender inequalities between 45 countries across 10 health indicators among adolescents and whether those differences in health correlate with gender inequality in general. METHODS: Data from 71,942 students aged 15 years from 45 countries who participated in the 2018 Health Behaviour in School-aged Children survey were analyzed. For this purpose, 10 indicators were selected, representing a broad spectrum of health outcomes. The gender differences in the countries were first presented using odds ratios. Countries with similar risk profiles were grouped together using cluster analyses. For each of the 10 indicators, the correlation with the Gender Inequality Index was examined. RESULTS: The cluster analysis reveals systematic gender inequalities, as the countries can be divided into seven distinct groups with similar gender inequality patterns. For eight of the 10 health indicators, there is a negative correlation with the Gender Inequality Index: the greater the gender equality in a country, the higher the odds that girls feel fat, have low support from families, have low life satisfaction, have multiple health complaints, smoke, drink alcohol, feel school pressure, and are overweight compared with boys. Four indicators show a divergence: the higher the gender equality in a country in general, the larger the differences between boys and girls regarding life satisfaction, school pressure, multiple health complaints, and feeling fat. CONCLUSIONS: Countries that are geographically and historically linked are similar in terms of the health risks for boys and girls. The results challenge the assumption that greater gender equality is always associated with greater health equality.

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

PURPOSE: Previous research has shown inconsistent time trends in adolescent mental well-being, but potential underlying mechanisms for such trends are yet to be examined. This study investigates cross-national time trends in adolescent mental well-being (psychosomatic health complaints and life satisfaction) in mainly European countries and the extent to which time trends in schoolwork pressure explain these trends. METHODS: Data from 915,054 adolescents from 36 countries (50.8% girls; meanage = 13.54; standard deviationage = 1.63) across five Health Behaviour in School-aged Children surveys (2002, 2006, 2010, 2014, and 2018) were included in the analyses. Hierarchical multilevel models estimated cross-national trends in adolescent mental well-being and schoolwork pressure. We also tested whether schoolwork pressure could explain these trends in mental well-being. RESULTS: A small linear increase over time in psychosomatic complaints and schoolwork pressure was found. No change in life satisfaction emerged. Furthermore, there was large cross-country variation in the prevalence of, and trends over time in, adolescent mental well-being and schoolwork pressure. Overall, declines in well-being and increases in schoolwork pressure were apparent in the higher income countries. Across countries, the small increase in schoolwork pressure over time partly explained the decline in psychosomatic health complaints. CONCLUSIONS: Our findings do not provide evidence for substantial declines in mental well-being among adolescents. Yet, the small declines in mental well-being and increases in schoolwork pressure appear to be quite consistent across high-income countries. This calls for the attention of public health professionals and policy-makers. Country differences in trends in both adolescent mental well-being outcomes and schoolwork pressure were considerable, which requires caution regarding the cross-national generalization of national trends.

Suicide prevention: Using the number of health complaints as an indirect alternative for screening suicidal adolescents.

BACKGROUND: Suicide is the second leading cause of death in adolescents. Screening for persons at risk usually includes asking about suicidal ideation, which is considered inappropriate in some societies and situations. To avoid directly addressing suicide, this paper investigates whether the Health Behaviour in School-aged Children Symptom Checklist (HBSC-SCL), a validated non-clinical measure of eight subjective health complaints (e.g. headache, feeling low), could be used as a tool for screening suicidal ideation and behavior in adolescents. METHODS: 5262 secondary school students aged 12-18 answered the Luxembourgish HBSC 2014 survey, including the HBSC-SCL items and suicidal ideation and behavior questions. RESULTS: Each HBSC-SCL item correlates with suicidal ideation and behavior. A sum score was calculated ranging from zero to eight health complaints to predict respondents who considered suicide (area under the ROC curve = 0.770). The ideal cut-off for screening students who consider suicide is three or more health complaints: sensitivity is 66.3%, specificity is 75.9% and positive predictive value is 32.9%. LIMITATIONS: One limitation is HBSC-SCL's low positive predictive value. This is a general problem of screening rare events: the lower the prevalence, the lower the positive predictive value. Sensitivity and specificity could be improved by taking age-, gender- and country-specific cut-off values, but such refinements would make the score calculation more complicated. CONCLUSIONS: The HBSC-SCL is short, easy to use, with satisfactory screening properties. The checklist can be used when suicide cannot be addressed directly, and also in a more general context, e.g. by school nurses when screening adolescents.

Illness perception and quality of life of HIV-positive persons: mediation effects of tenacious and flexible goal pursuit.

Medical advances contribute to raise life expectancy of people living with HIV/AIDS (PLHIV). However, they still face challenges related to the disease, thus, quality of life (QOL) became a priority on the field. The self-regulatory model (SRM) guided this study. Illness perceptions (IP) are the beliefs, cognitions, representations of a disease, impacting PLHIV coping strategies and QOL. Tenacious goal pursuit (TGP) is the pursuit of goals with determination, flexible goal adjustment (FGA) is doing it with flexibility, disengaging if necessary, they can both be considered as coping strategies. This study aims to measure the impact of HIV Perception in the QOL of PLHIV mediated by the TGP and FGA. Data was collected from 196 PLHIV with the WHOQOL-HIV Bref, the Brief-IPQ and the FGA and TGP scales. Structural equation model provided a good fit consistent with the theoretical SRM. IP, TGP and FGA had direct effects on the QOL of PLHIV. IP had also an indirect effect (partially mediated by TGP/FGA), suggesting that TGP/FGA reduce the impact of a threatening IP in the QOL. Goal oriented interventions should focus in the HIV perception of PLHIV to ameliorate their QOL.

Qualidade de vida de pessoas vivendo com HIV/aids: efeitos da percepção da doença e de estratégias de enfrentamento / Quality of life of people living with HIV/AIDS: Effects of illness perception and coping strategies

RESUMO A pesquisa objetivou investigar preditores da qualidade de vida (QV) de pessoas vivendo com HIV/aids (PVHA), baseada no modelo de autorregulação de Leventhal, no qual a influência da percepção da doença na QV é mediada por estratégias de enfrentamento. Foram 95 PVHA a responder aos instrumentos Brief IPQ, Brief Cope e WHOQOL-HIV Bref relativos, respectivamente, à percepção da doença, estratégias de enfrentamento e QV. Os resultados indicaram que a percepção da doença teve efeito direto e indireto na QV, mediado por estratégias de enfrentamento. Maior percepção de ameaça da doença associou-se à pior QV percebida; porém, o uso mais frequente das estratégias aceitação, distração e suporte instrumental e a menor utilização de desengajamento comportamental e de reinterpretação positiva amenizaram esse efeito negativo.

ABSTRACT This study aims to investigate the quality of life (QOL) predictors of people living with HIV/AIDS (PLWHA), from the perspective of Leventhal’s Self-Regulation Model, in which the influence of the illness perception on QOL is mediated by coping strategies. Ninety-five PLWHA answered to the instruments Brief IPQ, Brief Cope and WHOQOL-HIV BREF concerning, respectively, illness perception, coping strategies and QOL. The results indicate that illness perception has direct and indirect effects in QOL, mediated by coping strategies. The more HIV is perceived as threatening, the worse is the perception of QOL of PLWHA; however, the increased use of acceptance, distraction and instrumental support coping strategies and the less use of behavioral disengagement and positive reinterpretation could mitigate this negative effect.