Impact of temporomandibular disorder symptoms among 15-year-old girls.

OBJECTIVE: Many adolescents, especially girls, report temporomandibular disorder (TMD) symptoms that may impact their daily life. METHODS: At 19 different schools participating in the preventive program with dental nurses of FRAMM (Fluoride, Advise, Arena, Motivation, Food), at the Västra Götaland Region in Sweden, 15-year-old girls were invited to a cohort study about symptoms of TMD that also included headaches. Three hundred twenty-nine girls attended the study and answered a questionnaire regarding TMD symptoms and their consequences such as sick leave from school and consumption of analgesics. The girls were asked about the symptom's influence on their daily life, about their general health, use of regular medication, physical activity, and they answered the PHQ4 regarding experienced symptoms of anxiety and depression. RESULTS: There was a significant correlation between TMD symptoms and sick leave with 31% of the girls having stayed home due to symptoms. Of the girls who answered affirmative in the screening questions (3QTMD), nearly half the group had stayed at home due to their symptoms, 24% had consulted a physician, 42% had used analgesics weekly and 59% reported that they felt the symptoms negatively affected their school performance. The girls who had regular medication had more TMD symptoms. Anxiety and depression were associated with TMD symptoms. CONCLUSION: The study showed that TMD symptoms had a negative impact on the 15-year-old girls' daily life resulting in sick leave from school, consumption of analgesics, and experiences of negative impacts on their behavior and performance at school.

Relationship between Eczema and Self-reported Difficulties Keeping up with School Education: A Cross-sectional Study.

Eczema is a common chronic disease that affects both children and adults, and may have an adverse impact on school performance, as it is characteristically pruritic, and hence may lead to poor concentration and inadequate sleep. The aim of this study was to elucidate the relationship between eczema and self-reported difficulties keeping up with school education. The study was based on cross-sectional questionnaire data collected in schools among all 9th graders (15-16 years old) within a Swedish county. Logistic regression analyses were used to assess the association between having eczema and self-reported difficulties keeping up with school education. A total of 2,620 pupils participated (50.1% female). An increased odds ratio (OR) of self-reported difficulties keeping up with school education was found in adolescents with eczema compared with those without eczema after adjustment for sex and  family residence (OR 2.13, 95% confidence interval (95% CI) 1.32-3.44), and with additional adjustment for sleeping problems, attention-deficit hyperactivity disorder, allergy, rhinitis, asthma, and alcohol consumption (adjusted OR 1.78, CI 1.05-3.00). Eczema may be a relevant risk factor for difficulty keeping up with school education in adolescents. However, studies that can assess temporality, based in different settings with objective reports of both eczema and self-reported difficulties at school, are needed to confirm these findings.

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.

Improvements in the school environment-results of a Swedish school project 2005-2011.

To examine whether a public health project to reduce problem behavior in schools and improve the classroom climate, undertaken among eight secondary schools in a municipality in Sweden, was accompanied by favorable changes in the school environment over time. Data were collected from ninth grade students (aged 15-16 years) at three different time points: the year before the project began (2005), during the project (2008) and when the project finished (2011). Changes in the school environment, measured as damage, littering, noise and classroom disorder, were compared between the project municipality and a comparison group of other municipalities in the same county, using multinomial logistic regression analysis. Descriptive comparisons were made between the schools within the project municipality. The school environment improved significantly from 2005 to 2011 in the project municipality compared with the other municipalities. The school environment was improved in all schools within the project municipality. The biggest improvements took place in two schools which systematically worked with one program incorporated into the school schedule. This study demonstrates that it may be possible to improve the school environment by implementing health programs. Further studies based on experimental designs are required in order to confirm the potential and efficiency of school health programs.

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.

Explaining differential item functioning focusing on the crucial role of external information - an example from the measurement of adolescent mental health.

BACKGROUND: An overarching objective in research comparing different sample groups is to ensure that the reported differences in outcomes are not affected by differences between groups in the functioning of the measurement instruments, i.e. the items have to work in the same way for the different sample groups to be compared. Lack of invariance across sample groups are commonly called Differential Item Functioning (DIF). There is a sense in which the DIF of an item can be taken account of by resolving (splitting) the item into group specific items, rather than deleting the item. Resolving improves fit, retains the reliability and content provided by the item, and compensates for the DIF in estimation of person parameters on the scale of the instrument. However, it destroys invariance of the item's parameter value among the groups. Whether or not a DIF item should be resolved depends on whether the source of the DIF is relevant or irrelevant for the content of the variable. The present paper shows how external information can be used to investigate if the gender DIF found in the item "Stomach ache" in a psychosomatic symptoms scale used among adolescents may reflect abdominal pain because of a biological factor, the girls' menstrual periods. METHODS: Swedish data from the international Health Behaviour in School-aged Children study (HBSC) collected in 2005/06, 2009/10 and 2013/14 were used, comprising a total of 18,983 students in grades 5, 7 and 9. A composite measure of eight items of psychosomatic problems was analysed for DIF with respect to gender and menstrual periods using the Rasch model. RESULTS: The results support the hypothesis that the source of the gender DIF for the item "Stomach ache" is a gender specific biological factor. In that case the DIF should be resolved if the psychosomatic measure is not intended to tap information about abdominal pain caused by a gender specific biological factor. In contrast, if the measure is intended to tap such information, the DIF should not be resolved. CONCLUSIONS: The conceptualisation of the measure governs whether the item showing DIF should be resolved or not.

Cross-country comparisons of trends in adolescent psychosomatic symptoms - a Rasch analysis of HBSC data from four Nordic countries.

BACKGROUND: To analyse the psychometric properties of the HBSC Symptom Checklist (HBSC-SCL) on psychosomatic symptoms with a focus on the operating characteristics of the items, and on the impacts of measurement distortions on the comparisons of person measures across time and between countries. METHODS: Data were collected in 1993/94, 1997/98, 2001/02, 2005/06, 2008/09, 2013/14 in Denmark, Finland, Norway and Sweden as part of the Health Behaviour in School-aged Children (HBSC) study. Data comprised 116,531 students 11, 13 and 15 years old. Rasch analysis was conducted of the HBSC-SCL consisting of eight items with a focus on Differential Item Functioning (DIF) and item threshold ordering. The impacts of DIF and threshold disordering on trend analyses were analysed in a subsample consisting of 15 years old students. RESULTS: One item shows evidence of severe DIF and the categorisation of some items does not seem to work as intended. Analyses of changes based on proportions of psychosomatic symptoms show that bad item functioning affects some comparisons between countries across time: A four percentage point difference between 15 years old girls in Finland and Sweden concerning the rate of increase of psychosomatic symptoms from 1994 to 2014 disappears when the problems with DIF and disordered item thresholds are taken into account. Although the proportions of students with psychosomatic symptoms are clearly higher 2014 than 1994 in all four countries the shape of most trends is nonlinear. CONCLUSIONS: Some of the cross-country comparisons were distorted because of DIF and problems related to disordering of the item thresholds. The comparisons among girls between Finland and Sweden were affected by the problems pertaining to the original measure of psychosomatic symptoms, while the trend patterns among boys were not much affected. In addition to confirming increasing rates of adolescent mental health problems in the Nordic countries, the substantive analyses in the current study show that Finland is joining Sweden in having the sharpest increase among older adolescents, in particular among girls. To improve the functioning of the scale the DIF item could be removed or replaced and response categories collapsed in post hoc analyses.

Self-reported school demands and psychosomatic problems among adolescents - changes in the association between 1988 and 2011?

AIMS: The aim of the present study was to examine changes over time in the relationship between self-reported school demands and psychosomatic problems, also considering the impact of student influence and teacher support. METHODS: Data from a cross-sectional study (Young in Värmland) including eight data collections (1988-2011) among Swedish students aged 15-16 were used ( n = 20,115). Analyses with multinomial logistic regression and descriptive statistics were applied. RESULTS: Between 1988 and 2011, the proportions of students with a higher degree of psychosomatic problems increased, as did the proportion of students experiencing school demands that were too high. Finer-level analyses based on stratification of student groups did not show any associations at the aggregated level between increases of school demands and psychosomatic problems. Similarly, individual level analyses showed that the strength of the association between school demands and psychosomatic problems was not affected by year of investigation. CONCLUSIONS: Changes in school demands over time could not explain the increasing trend in psychosomatic problems among adolescents. Since the relationship between school demands and psychosomatic problems is strong across time, there is, however, a continued need for school-based interventions. More studies are required to gain further understanding of adolescent mental health from a trend perspective.

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.

Towards explaining time trends in adolescents' alcohol use: a multilevel analysis of Swedish data from 1988 to 2011.

BACKGROUND: Alcohol use has decreased among Swedish adolescents in the past few decades. We examined peer and parent factors (i.e. time spent with peers, time spent with parents and parental monitoring) that could contribute to explaining this trend by investigating their main effects and interaction effects with investigation years on alcohol use. We furthermore examined whether municipality-level socioeconomic conditions could contribute to explaining the trend. METHODS: We used data from a repeated cross-sectional study that took place eight times between 1988 and 2011. The study targeted all ninth grade students (15-16 years old) in Värmland County, Sweden. Adolescents (N = 22 257) reported their monthly alcohol use, time spent with peers and parents and parental monitoring. Municipality-level socioeconomic conditions were based on parent education levels. RESULTS: Logistic multilevel regression analyses showed that peer and parent factors and municipality-level socioeconomic conditions were associated with alcohol use among adolescents. The interaction effects between peer and parent factors and investigation years were not significant. The decreased trend in time spent with peers was associated with the decreased trend in frequency of alcohol use over time. CONCLUSIONS: The findings of the current study provide an indication that the decreased trend in alcohol use that has been observed in Swedish adolescents over the past few decades may be related to changes in adolescents' social interactions with peers.

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.

The association between physical activity and symptoms of depression in different contexts - a cross-sectional study of Norwegian adolescents.

BACKGROUND: The purpose was to analyse the association between physical activity taking place in different contexts (sports club, gym, exercise independently and other organized physical activities) and symptoms of depression. METHODS: The study was based on self-reported cross-sectional data from the Ungdata survey, conducted in 2017 by the Norwegian Social Research (NOVA) institute in cooperation with regional centres for drug rehabilitation. The target group comprised 5531 15-16 years old adolescents (Grade 10 students) and 11,655 students in grades 8 and 9 in Norway. Based on Rasch analysis, six items on depressions symptoms were used to create a composite measure of depression. Binomial logistic regression was used to analyse the association between physical activities in different contexts and symptoms of depression. RESULTS: In the crude model, the odds for symptoms of depression were lower for those who were physically active in a sports club (OR: 0.40, 95% CI: 0.30-0.53), in a sports club and gym (OR: 0.40, 95% CI: 0.28-0.56), in a sports club and exercise or keep fit independently (OR: 0.52, 95% CI: 0.38-0.72) and in a sports club, gym and exercise or keep fit independently (OR: 0.58, 95% CI: 0.41-0.81). After adjustment for potential confounders, the association became significant only for those who were physically active in a sports club (OR: 0.57, 95% CI: 0.40-0.81) and other organized physical activities, e.g. dance, martial arts (OR: 0.52, 95% CI: 0.31-0.86). Analysis for grade 8 and 9 showed the same patterns for the associations between sports club and symptoms of depression (grade 8: crude model, OR: 0.47, adjusted model, OR: 0.63, grade 9: crude model, OR: 0.44, adjusted model, OR: 0.49). CONCLUSIONS: Physical activity in a sports club was associated with significantly lower odds for symptoms of depression, suggesting a possible role for social interaction in addition to physical activity per se. It is important, therefore, to consider in which types of contexts physical activities take place, not only focusing on physical activity frequency and volume when investigating the association between adolescents' physical activity and mental health. Additional research is needed to further explore these associations as well as measures of physical activity and mental health.

Child and adolescent sleep duration recommendations in relation to psychological and somatic complaints based on data between 1985 and 2013 from 11 to 15 year-olds.

PURPOSE: To investigate the association between sleep duration, sleep initiation difficulties and psychological and somatic complaints. METHODS: We used three cohorts of cross-sectional Swedish questionnaire data, from the Health Behaviours of School aged Children (1985/1986, 2005/2006, 2013/2014, n=>18 000, aged 11-15). Specific complaints (e.g. pain) and total complaint load were used as outcomes of sleep duration, sleep initiation difficulties and the combination of them both. RESULTS: Sleeping less than recommended and sleep initiation difficulties were associated with increased odds of specific complaints and belonging to the group with the greatest complaint load. The combination of short sleep duration and sleep initiation difficulties were associated with higher odds than either sleep issue alone. No interaction effects between time and sleep variables were found regarding complaints. CONCLUSIONS: The findings support recent sleep duration recommendations. Further, sleep issues warrant a broad health assessment as they indicate a high likelihood of other complaints.

The Psychometric Properties of the Swedish Version of the General Self-Efficacy Scale: A Rasch Analysis Based on Adolescent Data.

Self-efficacy describes people's belief in their own ability to perform the behaviors required to produce a desired outcome. The purpose of this study was to examine the psychometric properties of the Swedish version of the General Self-Efficacy Scale (GSES) with an adolescent sample, using Rasch analysis. The scale was examined with a focus on invariant functioning along the latent trait as well as across sample groups. The data were collected 2009 and 2010 among 3764 students aged between 13 and 15 years, in the 7th to 9th grade, in compulsory schools in the municipality of Karlstad, Sweden. The item fit was acceptable, the categorization of the items worked well and the scale worked invariantly between years of investigations. Although the GSES worked well as a whole, there was some evidence of misfit indicating room for improvements. The targeting may be improved by adding more questions of medium difficulty. Also, further attention needs to be paid to the dimensionality of the GSES as well as to whether the psychometric properties of GSES are affected by using more recent data.

Recent advances in analysis of differential item functioning in health research using the Rasch model.

BACKGROUND: Rasch analysis with a focus on Differential Item Functioning (DIF) is increasingly used for examination of psychometric properties of health outcome measures. To take account of DIF in order to retain precision of measurement, split of DIF-items into separate sample specific items has become a frequently used technique. The purpose of the paper is to present and summarise recent advances of analysis of DIF in a unified methodology. In particular, the paper focuses on the use of analysis of variance (ANOVA) as a method to simultaneously detect uniform and non-uniform DIF, the need to distinguish between real and artificial DIF and the trade-off between reliability and validity. An illustrative example from health research is used to demonstrate how DIF, in this case between genders, can be identified, quantified and under specific circumstances accounted for using the Rasch model. METHODS: Rasch analyses of DIF were conducted of a composite measure of psychosomatic problems using Swedish data from the Health Behaviour in School-aged Children study for grade 9 students collected during the 1985-2014 time periods. RESULTS: The procedures demonstrate how DIF can be identified efficiently by ANOVA of residuals, and how the magnitude of DIF can be quantified and potentially accounted for by resolving items according to identifiable groups and using principles of test equating on the resolved items. The results of the analysis also show that the real DIF in some items does affect person measurement estimates. CONCLUSIONS: Firstly, in order to distinguish between real and artificial DIF, the items showing DIF initially should not be resolved simultaneously but sequentially. Secondly, while resolving instead of deleting a DIF item may retain reliability, both options may affect the content validity negatively. Resolving items with DIF is not justified if the source of the DIF is relevant for the content of the variable; then resolving DIF may deteriorate the validity of the instrument. Generally, decisions on resolving items to deal with DIF should also rely on external information.

Changes in sleep habits between 1985 and 2013 among children and adolescents in Sweden.

AIMS: The aim was to investigate changes in child and adolescent sleep habits in Sweden over time. This had not been done previously. METHODS: Cross-sectional questionnaire data over three decades of investigations of the Health Behaviours of School Children study (1985/1986, 2005/2006 and 2013/2014) were used. The sample included 18,682 children and adolescents, aged 11, 13 and 15. Empirically based age-specific sleep duration recommendations were used to operationalise sleep duration. RESULTS: The results showed that, over time, fewer go to bed early and more go to bed late. Regarding sleep duration, there have been decreases in the proportion of children and adolescents that sleep as much as is recommended for their age. Sleep onset difficulties have increased for all ages and increase the odds of sleeping less than recommended as well as having late bedtimes. Boys were more likely than girls to have later bedtimes and to sleep less than recommended. A vocational educational track, not planning to study further or being unsure of which track to choose increased the odds for 15 year olds to have late bedtimes and to sleep less than recommended compared with a college preparatory track. CONCLUSIONS: The results indicate that over time, fewer children and adolescents attain sufficient sleep duration. This may have implications for study results, mental health and cognitive abilities.

Semantics bias in cross-national comparative analyses: is it good or bad to have "fair" health?

The Health Behavior in School-aged Children is a cross-national study collecting data on social and health indicators on adolescents in 43 countries. The study provides comparable data on health behaviors and health outcomes through the use of a common protocol, which have been a back bone of the study sine its initiation in 1983. Recent years, researchers within the study have noticed a questionable comparability on the widely used item on self-rated health. One of the four response categories to the item "Would you say your health is….?" showed particular variation, as the response category "Fair" varied from 20 % in Latvia and Moldova to 3-4 % in Bulgaria and Macedonia. A qualitative mini-survey of the back-translations showed that the response category "Fair" had a negative slant in 25 countries, a positive slant in 10 countries and was considered neutral in 9 countries. This finding indicates that there are what may be called semantic issues affecting comparability in international studies, since the same original word (in an English original) is interpreted differently across countries and cultures. The paper test and discuss a few possible explanations to this, however, only leaving to future studies to hold a cautious approach to international comparisons if working with the self-rated health item with four response categories.

The psychometric properties of the Hopkins Symptom Checklist-10: a Rasch analysis based on adolescent data from Norway.

BACKGROUND: The Hopkins Symptom Checklist (HSCL-10) is widely used for both clinical and epidemiological purposes to measure psychological distress among adolescents and adults. OBJECTIVE: The purpose of this study was to investigate the psychometric properties of the HSCL-10 among adolescents in Norway using Rasch analysis. METHODS: The study is based on cross-sectional data from the Norwegian Youth Health Surveys, conducted by the Norwegian Institute of Public Health in 2001 and 2009. The target group comprised of 15- to 16-year olds (Grade 10 students) in Hedmark County, Norway. Ten items with four response categories, intended to measure anxiety and depression, were analysed. The analysis focused on invariance, including differential item functioning (DIF) across genders and years of investigations. In addition, the categorization of the items, targeting, possible multidimensionality and response dependency, was analysed. RESULTS: The HSCL-10 shows good reliability and on the whole, the items work well. However, one item, 'Sleeping difficulties', clearly misfit and some items work differently for boys and girls and between years of investigations. There is also need for a better targeting of the scale. CONCLUSIONS: The HSCL-10 has the potential to measure the psychological distress among adolescents but there is a room for improvement. Further judgement needs to be made as to whether the misfitting item 'Sleeping difficulties' should be removed or retained.

Family residency and psychosomatic problems among adolescents in Sweden: The impact of child-parent relations.

AIMS: Profound changes in family structure took place in many countries, during the second part of the previous century. The purpose of this paper is to analyse the association between the type of family residency and psychosomatic problems in younger and older adolescents, particularly focusing on alternate residency, and to examine the impact of child-parent relations. METHODS: We used data collected in 2009 by Statistics Sweden among 172,298 Swedish students in Grade 6 and Grade 9 (approximate ages 12 and 15 years old); comprising 80% and 86%, respectively, of the entire population of students in those grades. We collected the data with a questionnaire, completed anonymously in school: We used the Psychosomatic Problems (PSP) scale as the outcome measure. RESULTS: The type of family residency showed a weaker association with psychosomatic problems than the child-parent relationships did. Living in non-intact families increased the probability of adolescent psychosomatic problems by 0-0.05, compared to intact families. In Grade 9, there were no differences in psychosomatic problems between the students in alternate residency and those living with their two parents; and in Grade 6, these differences were relatively small. In comparison, a worse relationship with parents increased the probability of psychosomatic problems by 0.11-0.17, depending on the school grade and type of family residency. CONCLUSIONS: The structure of the family, as well as the child-parent relationships needs to be taken into account, to properly estimate the magnitude of the family situation as a determinant of adolescent psychosomatic problems. Our results justify universal intervention at the policy level.

The association between medical conditions and gender, well-being, psychosomatic complaints as well as school adaptability.

AIM: The aim was to assess the association between medical conditions and gender, well-being, psychosomatic complaints and school adaptability. The second aim was to determine whether self-reported medical conditions should be included in class-room questionnaires that deal with well-being and risk behaviour. METHODS: A cross-sectional class-room questionnaire was given to all 15- to 16-year-olds within a Swedish county. The questionnaire included background factors, subjective health, well-being, psychosomatic complaints, self image, drug use and also several themes from the school context. In addition, there were 13 medical conditions/problems to tick (yes or no) and an open alternative for other problems/medical conditions. RESULTS: 3108 questionnaires (response rate 84%) were analysed. The majority of the girls and the boys reported no medical conditions; however, 49% of the girls and 39% of the boys reported at least one medical condition. The medical conditions were associated with gender, well-being, psychosomatic complaints and school adaptability. The association was stronger for girls than for boys. CONCLUSION: Medical conditions among these teenagers were associated with gender, well-being, psychosomatic complaints and school adaptability, particularly for girls. Our results suggest that medical conditions could preferably be included in regular classroom questionnaires.