Edited by: Janya McCalman, Central Queensland University, Australia
Reviewed by: Geoffrey Spurling, The University of Queensland, Australia; Hermona Soreq, Hebrew University of Jerusalem, Israel
This article was submitted to Children and Health, a section of the journal Frontiers in Public Health
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Many different aspects, inherent and contextual, affect young people's psychological and physical health during adolescence. Biological, psycho-developmental, and social changes, that take place almost simultaneously during this developmental period (
Why the changes mentioned above are general, there are also gender-specific patterns in the adolescent developmental phase. Young females usually exhibit an earlier social and cognitive maturation than their age-matched male counterparts (
Both female and male adolescents report that all types of supportive relationships which are based on reciprocity, understanding, and respect have a positive effect on their psychological health (
Parents' behavior toward their children during adolescence are essential for their children's well-being (
While relations of a destructive character can lead to mental distress (
The economic crisis during 1990 led to an intensified debate in Sweden concerning the young generation and their psychological health. Recommendations from an expert panel at the Royal Academy of Science to investigate and find the key issues behind mental ill-health among young people did not straighten out the question marks. Over the period of the deep economic recession in 2007 and 2008, actually a strong social net and support together with in-depth relief programmes in Sweden could compensate for the, in many other countries seen, worsened mental health (
Based on the findings from interdisciplinary research, a holistic approach, by which both somatic and mental health in a complex bio-psycho-social matrix are in focus, were found to be relevant and sought-after aspects of adolescent health research. To meet some of these goals, in the present study the prevalence and gender-specific distribution of self-reported somatic and mental health were investigated in a sample of Swedish high school students. The sample originated from an urban area, with an average Swedish socioeconomic status, on the West Coast of Sweden the year of 2018. Our aim with the present investigation is to contribute to the research area by searching for several underlying aggravating circumstances that might lead to adolescent health problems. The results presented may also open possibilities to compare perceived threats and problem areas on different levels in the youths' life, as well as effects of cultural and societal norms on their health.
The “Mental and Somatic Health without borders” (MeSHe) project (
The present study's data collection was performed at a high school in Western Sweden during a week in May 2018. Teachers were present in the entire survey, but students could work in privacy alone. The time devoted to the students to complete the questionnaires was 60 min. In the meantime, students who chose not to participate in the survey worked with an alternative task. Students who required extra time or support to fill in the questionnaire were offered help, which implied that those with reading/writing difficulties could be included in the survey. The students placed the completed survey in a separate, sealed envelope and gave it to the teacher.
The study population consisted of high school students in a medium-large city in the West part of Sweden. The inclusion criteria for participation were to be able to read and understand Swedish. The principal at the high school asked 407 students (17% studied at the Program of Business and Administration, 17% at the Program of Child and Recreation, and 66% at the Program of Business Management and Economics) about their interest in participating in the study. Of those who were asked to participate, 29.7% (121 students) chose not to participate in the study (attrition rate), which resulted in a response rate of 70.3% (286 students). Of 286 responding students, 46 (16%) did not fully complete the BSI questionnaires (internal dropout).
Moreover, one participant declared “other gender,” and four did not answer the question about their gender, adding a proportion of 1.75% of the data's internal dropout in the gender-specific analyzes. Thus, the final study population of 281 high school students (114 male and 167 female) were included in the gender-specific psychological distress analyses. The youngest participant in the study was 15 years old, the oldest 20 years old, and the average age of the study population was 17.30 years, with a standard deviation of 0.60 years.
The number of missing answers varied in the somatic health questionnaire section between zero/no missing answer (regarding complaints about constipation for a more extended period than 14 days) and nine (regarding previous head injuries), which resulted in a response frequency between 286 and 277 students. Due to four students who could not be categorized either as male or female gender, the gender-specific analyses of the prevalence of somatic complaints were based on answers from 163 to 164 females and 109 to 114 male students.
BSI is a self-assessment form that measures the individual's perceived mental distress (
Mental suffering can manifest itself in physical symptoms, such as cardiovascular, digestive and respiratory system or other areas affected by the autonomic nervous system (
Characteristic signs of obsessive compulsive behavior are recurrent and irresistible thoughts and actions such as repeatedly double-check if a task is performed, concentration difficulties, difficulties making decisions (
Social insecurity is considered to have a low intrinsic value, feelings of concern, being highly uncomfortable in social interactions (
A broad repertoire of symptoms indicate a state of depression, including dysfunctional effects, decreased interest in things that have been of interest before, low energy levels, and a sense of hopelessness (
This domain is characterized by typical symptoms of severe anxiety, such as unprovoked anxiety, panic attacks, muscle tension, restlessness, and nervousness (
The hostility domain is characterized by threatening behavior occurring in thought, emotion, and action. Standard features are to become easily irritated, get into trouble at a fast rate, feeling an urge to break something, and outbursts of anger (
Social phobia has a resemblance to agoraphobia, meaning that the person feels uneasy staying in a large human gathering, when using collective transport, or be in public places (
The paranoid mindset is assumed to be a natural syndrome experienced as symptoms with adverse effects, such as projection, hostility, distrust, self-centering, and suspicion that someone will deprive you of your autonomy (
This domain covers the area between a deviant lifestyle and total psychosis. Measured here is however, a non-clinical population's socially, abnormal behavior (
A part of the MeSHe survey, is a measure of the presence of selected physical complaints and diseases. The questionnaire was developed by the Swedish project leader (NK) and based on a similar questionnaire in a nation-wide twin study in Sweden (
The presence of
“Parental Substance use Problems” (PSP), i.e., those indicating having adults in their life with alcohol and/or drug use problems.
“Physical or Psychological Abuse” (PPA), i.e., those indicating having experienced physical and/or psychological abuse.
The comparison group (CG), i.e., those dissenting to all four questions regarding negative psychosocial factors.
The computer program Statistical Package for the Social Sciences (SPSS) software version 24.0 (IBM) was used for data analysis. Since data differed significantly from the normal distribution (
Concerning the somatic health dimension, contingency square analysis was performed to assess the relationship between somatic symptoms and diseases, on the one hand, and psychosocial variable groups, on the other. The strength of the statistically, significant relationship was evaluated using Cramer's V effect size [values from 0.07 to 0.20 indicate a small effect, 0.21 to 0.35 a medium effect, and 0.36 and above suggesting a large effect (
The Regional Ethical Review Board in Gothenburg approved the study; protocol No. 689 - 17. Ethical approval ensures that the study follows the Helsinki Declaration's and the Swedish law with ethical guidelines for scientific research on people. The Act on ethical review of research involving humans according to the Swedish Law (2003: 460) § 18 declares: “If the research person has reached the age of 15 but not 18 and realizes what the research means for him or her, he or she shall be informed of and consent to the research in the manner specified in §§ 16 and 17” (
Almost one third (29.6%) of the students reported no symptoms on the Brief Symptom Inventory (BSI) and about half of them (52.1%) experienced a low level of psychological distress. Moderate problems with distress was reported by 15% of the students, and a very high level of psychological distress by 3.2%. Mirroring the over-all distribution of the level of distress, the mean value of the students' psychological distress, measured with the General Severity Index (GSI), was 0.93 (
Self-reported psychiatric problems in the general population of a sample of Swedish adolescents (
Somatization | 0.78 (0.7) |
104 | 0.48 (0.5) |
160 | 0.98 (0.75) |
<0.001 | 0.12 |
Obsessive compulsive behavior | 1.30 (0.86) |
106 | 0.91 (0.73) |
163 | 1.55 (0.85) |
<0.001 | 0.13 |
Psychoticism | 0.56 (0.74) |
107 | 0.32 (0.59) |
164 | 0.71 (0.8) |
<0.001 | 0.07 |
Depression | 1.04 (0.94) |
104 | 0.64 (0.74) |
163 | 1.30 (0.96) |
<0.001 | 0.12 |
Interpersonal sensitivity | 0.97 (0.99) |
108 | 0.48 (0.68) |
162 | 1.30 (1.04) |
<0.001 | 0.16 |
Hostility | 0.88 (0.8) |
108 | 0.73 (0.78) |
164 | 0.97 (0.81) |
0.012 | 0.02 |
Phobic anxiety | 0.61 (0.82) |
106 | 0.22 (0.52) |
162 | 0.86 (0.87) |
<0.001 | 0.15 |
Anxiety | 1.11 (0.87) |
102 | 0.61 (0.58) |
166 | 1.42 (0.87) |
<0.001 | 0.21 |
Paranoid ideation | 1.05 (0.89) |
108 | 0.69 (0.76) |
164 | 1.28 (0.89) |
<0.001 | 0.11 |
GSI | 0.93 (0.68) |
92 | 0.60 (0.55) |
148 | 1.14 (0.68) |
<0.001 | 0.14 |
Results indicated that the female high school students had a significantly higher general level of psychological distress than the male students. In each BSI domain, female students compared to their male classmates, estimated their psychological distress level higher (each of those with large effect size, except Psychoticism with medium effect size, and Hostility with a small effect size). The domains that were found to distinguish the genders by effect size at most were Anxiety (Eta2 = 0.21) and Interpersonal sensitivity/social insecurity (Eta2 = 0.16).
Half (51.3%) of the students reported no somatic problems at all, another one-third of them (31.3%) indicated having one somatic complaint, and eight students (3.5%) three or more somatic complaints. The prevalence of somatic complaints was similarly distributed among female and male students (
Proportion of adolescents [male (
Prevalence of defined somatic symptoms and diseases in a sample of Swedish students (
Diarrhea | (7/260) |
(4/104) |
(3/156) |
0.83 | 0.36 | 0.06 |
Constipation | (17/253) |
(2/109) |
(15/144) |
6.45 | 0.008 | 0.16 |
Cancer | (1/272) |
(0/110) |
(1/162) |
0.68 | 0.41 | 0.05 |
Epilepsy | (3/274) |
(1/112) |
(2/162) |
0.07 | 0.79 | 0.02 |
Rheumatologic disease | (5/268) |
(2/109) |
(3/159) |
0.01 | 0.98 | 0.02 |
Diabetes | (2/274) |
(1/112) |
(1/162) |
0.07 | 0.79 | 0.02 |
Asthma | (38/235) |
(15/96) |
(23/139) |
0.03 | 0.87 | 0.01 |
Other allergy | (84/187) |
(42/69) |
(42/118) |
4.11 | 0.040 | 0.12 |
Skin disease | (18/251) |
(5/104) |
(13/147) |
1.30 | 0.25 | 0.07 |
Gluten intolerance | (6/268) |
(3/108) |
(3/160) |
0.23 | 0.63 | 0.03 |
Migraine | (45/226) |
(12/96) |
(33/130) |
3.91 | 0.048 | 0.12 |
Thyroid disease | (2/269) |
(1/110) |
(1/159) |
0.07 | 0.79 | 0.02 |
The overlap of the affirmative answers to the four questions about negative psychosocial factors in the students' life, separated by gender, is illustrated in
The prevalence of male students reporting the existence of different negative psychosocial problems in a sample of Swedish high school students (
The prevalence of female students reporting the existence of different negative psychosocial problems in a sample of Swedish high school students (
None of the 165 responding female participants reported having adults with drug use problems in her life. Out of seven females (4%) reporting adults with alcohol use problems in their family, five had experienced abuse (
As students reporting both PSP and PPA were very few (two males and five females), no statistical analyses for this group were specifically performed; instead, their reports were accounted for in both the PSP and the PPA groups.
The presence of an adult(s) with substance use problem (PSP) in the students' life and the experience of physical and/or psychological abuse (PPA) contributed to an increased level of psychological distress in all primary dimensions as well as in the overall level of psychological distress (
Self-reported psychiatric distress level in a sample of Swedish adolescent's according to psychosocial variable groups.
Somatization | 0.62 (0.63) |
1.09 (0.87) |
0.97 (0.73) |
21.17 | <0.001 | CG < PPA |
Obsessive compulsive behavior | 1.08 (0.81) |
1.42 (0.88) |
1.56 (0.86) |
21.59 | <0.001 | CG < PPA |
Psychoticism | 0.36 (0.54) |
0.98 (0.92) |
0.78 (0.88) |
28.96 | <0.001 | CG < PPA |
Depression | 0.77 (0.8) |
1.53 (1.11) |
1.35 (0.99) |
29.58 | <0.001 | CG < PPA |
Inetrpersonal sensitivity | 0.7 (0.89) |
1.34 (1.01) |
1.29 (1.05AQ) |
29.06 | <0.001 | CG < PPA |
Hostility | 0.66 (0.65) |
0.98 (0.72) |
1.12 (0.9) |
20.92 | <0.001 | CG < PPA |
Phobic anxiety | 0.47 (0.72) |
0.85 (0.51) |
0.79 (0.91) |
17.54 | <0.001 | CG < PPA |
Anxiety | 0.82 (0.73) |
1.58 (0.86) |
1.43 (0.9) |
38.39 | <0.001 | CG < PPA |
Paranoid ideation | 0.71 (0.72) |
1.43 (1) |
1.39 (0.92) |
42.95 | <0.001 | CG < PPA |
GSI | 0.72 (0.6) |
1.43 (0.69) |
1.17 (0.71) |
31.64 | <0.001 | CG < PPA |
A gender specific-pattern was discovered when we made separate analyses of changes in female and male students' psychological distress level in association with the two negative psychosocial factors (PSP and PPA). Male students who reported having parents with substance use problems (PSP) had a significantly increased level of Phobic anxiety compared to CG and PPA groups (
Self-reported psychiatric distress level in a sample of male adolescents according to psychosocial variable groups.
Somatization | 0.41 (0.4) |
0.43 (0.31) |
0.58 (0.63) |
2.08 | 0.35 | – |
Obsessive compulsive behavior | 0.77 (0.65) |
1.07 (0.89) |
1.13 (0.81) |
5.77 | 0.06 | – |
Psychoticism | 0.18 (0.33) |
0.56 (1.04) |
0.54 (0.8) |
12.00 | CG < PPA |
|
Depression | 0.51 (0.67) |
0.9 (1.32) |
0.83 (0.84) |
4.91 | 0.09 | – |
Interpersonal sensitivity | 0.35 (0.55) |
0.75 (1.13) |
0.68 (0.82) |
9.15 | CG < PPA |
|
Hostility | 0.57 (0.62) |
0.72 (0.56) |
0.96 (0.96) |
5.76 | 0.06 | – |
Phobic anxiety | 0.16 (0.4) |
0.52 (0.36) |
0.31 (0.69) |
9.59 | CG < PSP |
|
Anxiety | 0.43 (0.41) |
0.79 (0.83) |
0.85 (0.71) |
11.99 | CG < PPA |
|
paranoid ideation | 0.47 (0.59) |
1.61 (0.88) |
0.95 (0.83) |
12.07 | CG < PPA |
|
GSI | 0.44 (0.4) |
1.03 (0.99) |
0.80 (0.68) |
10.31 | CG < PPA |
A significant increased GSI and complaints in each of the nine primary domains were found in female students who reported one or several negative, psychosocial factor(s) in their life (
Self-reported psychiatric distress level in a sample of female adolescents according to psychosocial variable groups.
Somatization | 0.78 (0.72) |
1.47 (0.87) |
1.16 (0.7) |
16.50 | <0.001 | CG < PPA |
Obsessive compulsive behavior | 1.32 (0.84) |
1.77 (0.8) |
1.78 (0.81) |
12.98 | 0.002 | CG < PPA |
Psychoticism | 0.50 (0.63) |
1.29 (0.76) |
0.91 (0.9) |
16.72 | <0.001 | CG < PPA |
Depression | 0.97 (0.84) |
1.98 (0.73) |
1.62 (0.96) |
25.36 | <0.001 | CG < PPA |
Interpersonal sensitivity | 0.99 (1.00) |
1.83 (0.63) |
1.59 (1.02) |
18.06 | <0.001 | CG < PPA |
Hostility | 0.73 (0.67) |
1.17 (0.79) |
1.2 (0.86) |
14.13 | 0.001 | CG < PPA |
Phobic anxiety | 0.71 (0.81) |
1.13 (0.47) |
1.03 (0.91) |
9.07 | 0.01 | CG < PPA |
Anxiety | 1.09 (0.79) |
2.02 (0.5) |
1.70 (0.85) |
26.60 | <0.001 | CG < PPA |
Paranoid ideation | 0.90 (0.76) |
1.74 (0.72) |
1.61 (0.88) |
28.94 | <0.001 | CG < PPA |
GSI | 0.91 (0.63) |
1.72 (1.44) |
1.36 (0.65) |
22.85 | <0.001 | CG < PPA |
The most dramatic risk increase considering the prevalence of somatic complaints was found in the few participants who belong to the PSP group. For them the risk of having epilepsy increased 22 times (RR = 22.00), followed by approximately six times increased risk of having rheumatoid complaints (RR = 5.93) and gluten intolerance (RR = 5.50), and almost five times increased risk of constipation (RR = 4.64). Moreover, participants in the PSP group had a tripled risk to suffer from migraines (RR = 2.96). For those belonging to the PPA group, the risk to suffer from epilepsy (RR = 3.29), diarrhea (RR = 2.93), and constipation (RR = 2.92) were close to tripled, while the risk of having gluten intolerance and rheumatoid diseases (both values: RR = 2.21) was doubled (
Prevalence and risk ratio (RR) of defined somatic symptoms and diseases according to psychosocial groups.
Diarrhea | 1.4 | 0.0 | 0.00 | 4.1 | 2.93 | 2.21 | 0.33 | 0.09 |
Constipation | 3.6 | 16.7 | 4.64 | 10.5 | 2.92 | 4.28 | 0.12 | 0.13 |
Cancer | 0.0 | 0.0 | 0.00 | 0.8 | – | 1.22 | 0.54 | 0.07 |
Epilepsy | 0.7 | 15.4 | 22.00 | 2.3 | 3.29 | 4.59 | 0.10 | 0.13 |
Rheumatologic disease | 1.4 | 8.3 | 5.93 | 3.1 | 2.21 | 0.56 | 0.75 | 0.05 |
Diabetes | 1.4 | 0.0 | 0.00 | 0.0 | 0.00 | 1.99 | 0.37 | 0.09 |
Asthma | 12.2 | 15.4 | 1.26 | 14.8 | 1.21 | 0.54 | 0.76 | 0.04 |
Allergy | 30.2 | 41.7 | 1.38 | 30.4 | 1.00 | 0.66 | 0.72 | 0.05 |
Skin disease | 7.4 | 0.0 | 0.00 | 6.3 | 0.85 | 0.99 | 0.61 | 0.06 |
Gluten intolerance | 1.4 | 7.7 | 5.50 | 3.1 | 2.21 | 2.5 | 0.29 | 0.09 |
Migraine | 13.0 | 38.5 | 2.96 | 19.5 | 1.50 | 7.00 | 0.03 | 0.16 |
Thyroid disease | 0.7 | 0.0 | 0.00 | 0.8 | 1.14 | 0.08 | 0.96 | 0.02 |
The measure of the General Severity Index (GSI) can be used as an overall indicator of mental health complaints. However, to day, only a few studies have investigated self-reported psychological complaints in a general population of high-school students (
Psychological distress captured by BSI in the male and female adolescent populations of three countries' samples.
The finding that female students experienced a significantly higher level of psychological distress than their male counterparts seems to be constant when we compare in time or between cultures. In the present study, Swedish female students compared to male students reported a higher level of psychological distress on each of the BSI primary domaines, a result in accordance with previous studies performed in other countries [e.g., GSI scores for male and female students were 0.65 and 0.83 in the Israeli study in 1994, 1.20 and 1.54 in the Moroccan study in 2014, and 0.6 and 1.14 in the present study, respectively; (
An interesting detail of our study was that even hostility was rated higher by the female Swedish students (with a small effect size) compared to their male classmates. This finding has not previously been shown in adolescent populations in other countries. However, there are indications from previous studies that aggressive behavior (conduct disorder-like problem) is mostly influenced by specific environmental factors in girls (
Questions that captured the highest distress level in the Swedish high school students were feeling nervous, being blocked in getting things done, doubts whether or not others can be trusted, difficulties in decision making, and getting easily hurt. The highest scores found on the BSI domain level were on the Obsessive compulsive behavior, Anxiety, Paranoid Ideation and Depression domains. The most commonly reported psychological health problems, according to several other studies summarizing young peoples' health, are generalized anxiety, panic syndrome, social anxiety, and depression (
About 50% of the Swedish high school students reported one or several somatic complaints, a similar prevalence to that found in a large-scale nation-wide Swedish study including adolescents (
There is obviously a need to reflect on the fact that “only” a tiny number (0.4%) of Swedish high-school students reported problems with parental alcohol use and only one male student admitted to a parental drug use problem. In recent years, nearly 6% of the Swedish population are estimated to be either dependent on alcohol or abuse alcohol (
The strong cultural and societal impact on psychosocial environment in the youths' life could also be recognized in the prevalence of experienced physical or psychological abuse. An alarming number (47%) of the Swedish female adolescents—almost every second of them—and more than one third (37%) of the Swedish male adolescents reported the experience of some kind of abuse in their lives. Approximately 50% of them reported the experience of both physical and psychological abuse. In comparison, the prevalence of physical and psychological abuse reported by the female and male adolescents in the Moroccan study (
However, the impact of negative psychosocial factors on somatic and mental health can clearly be observed in both cultures (Swedish and Moroccan). The presence of any of the negative psychosocial factors was coupled with significantly worsened mental health (increased psychological distress) in our study, resembling the results found in the Moroccan population (
As described previously negative environmental circumstances can change adolescent brain development on both a structural and functional level (
The relationship between negative psychosocial factors and gastrointestinal problems is not a new finding. The experience of abuse is coupled to multi-component psycho-physiological consequences, which influence gastrointestinal reactivity, either directly or as a consequence of psychological comorbidities (
The augmentation of the risk of having rheumatological problems in students who report negative psychosocial factors highlights the role of multiple stressors and increasing vulnerability to autoimmune disease. In a recent Swedish register study, including data from over 100,000 adult patients with stress-related disorders, 10 times as many matched unexposed individuals, and in more than 120,000 full siblings the association between stress-related disorders and autoimmune diseases were further proven, mainly in younger ages (
There are several limitations to be recognized in the present study. The MeSHe project has a cross-sectional design; consequently, no conclusions about causal associations can be drawn from the collected data. In addition, the data collection was limited to one high school in West Sweden and therefore, generalization of the results should be cautiously made. However, in that school the response rate was high (70%), which is a strength of our study. The high response rate is the result of the organized data collection during teacher supervised classes—while still ensuring anonymity to all respondent. Students with reading or writing disabilities, attention problems, and other complaints, were offered extra time and special pedagogue's help in the understanding of the survey. Therefore we can assume that the final study population was a representative sample. An obvious limitation of the study is that the data collection is based on self-report. Although, it has been shown that self-reported data are accurate when individuals understand the questions and when there is a strong sense of anonymity. Considering the existence of different diagnoses among respondents, it is suggested that self-report may be used as a proxy, when register data are unavailable (
The results of the present study strengthen previous findings on gender differences in level of psychological distress and the significant impact of negative psychosocial factors on adolescents' physical and mental health. The study also presents new evidence about the decisive effect of culture and societal norms on the perception of threat and problem areas in the youths' life. The study concludes that the majority in the sample of Swedish high school students in 2018 reported none or very little psychological distress and none or only one somatic complaint. The most frequent psychological distress was coupled to obsession, anxiety, and the most frequent somatic complaint was allergy. Female students reported a higher level of psychological distress, but similar frequency of somatic complaints as their male classmates. The impact of parental substance use and the adolescents' experience of physical and/or psychological abuse seem to be substantial and a threat toward their mental health.
In future studies focusing on the enhancement of adolescent health and well-being we would suggest research approaches that are based on holistic methodology. The association between somatic and mental health and their susceptibility to the individual's unique and complex bio-psycho-social matrix is well-known and accepted today. However, health-, social care and educational systems are not yet adapted to this new and important knowledge. A significant, first step must be to make this comprehension available to all those who promote a life-long learning perspective and ensure that new academic programs are build on interdisciplinary grounds and holistic awareness.
The raw data supporting the conclusions of this article will be made available by the corresponding author upon request.
The studies involving human participants were reviewed and approved by the Regional Ethical Review Board in Gothenburg; protocol No. 689–17. Written informed consent from the participants' legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.
NK designed the study and grounded the MeSHe project, drafted the manuscript, supervised statistical calculations, and took responsibility for the intellectual content of the manuscript. BZ contributed to statistical analyses, took responsibility for the content of the results, and critically revised the manuscript. ST contributed to the manuscript with scientific responsibilities of references. SE contributed to the intellectual content and critically revision of the manuscript. All authors contributed to the article and approved the submitted version.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
We would like to acknowledge Linda Röine Baltra and Viola Pieper who prepared a bachelor thesis in the subject of measuring psychological distress of Swedish high school students in 2019 Spring semester in University West, Sweden with the supervision of ST. Our gratitude goes to professor Britt Hedman Ahlström and Jan Hovensjö who made the data collection possible by their enthusiastic work organizing contacts with the high school and by managing the logistics of data assessments.
Brief Symptom Inventory
comparison group
General Severity Index
mean
Mental and Somatic Health without borders
Physical and/or Psychological abuse
Parental Substance use Problems
risk ratio
standard deviation
Statistical Package for the Social Sciences.