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Depressive symptoms and the associations with individual, psychosocial, and structural determinants in Swedish adolescents
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. (Barns och ungas hälsa)ORCID iD: 0000-0003-3209-186X
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. (Barns och ungas hälsa)ORCID iD: 0000-0003-2996-3348
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. (Barns och ungas hälsa)ORCID iD: 0000-0003-2148-8044
2012 (English)In: Health, ISSN 1949-5005, Vol. 4, no 10, 881-889 p.Article in journal (Refereed) Published
Abstract [en]

Depressive symptoms in adolescents are an in-creasing public health issue in Sweden and in most Western countries. Aim: To explore how individual, psychosocial, and structural deter-minants are associated with depressive symp-toms in Swedish adolescents. Methods: A web- based questionnaire was answered by 1193 13- to 16-year-old boys (n = 566) and girls (n = 627). Stepwise logistic regressions were employed to analyse the association between depressive sym- ptoms and various determinants at the individ-ual level (self-efficacy), the psychosocial level (parental, peer, and teacher support, school de-mands, sexual harassment, and bullying) and the structural level (family affluence, having less money than friends, and parental foreign back-ground). Results: Determinants at the individual, psychosocial, and structural levels were inde-pendently associated with high levels of depres-sive symptoms in both boys and girls. The full model explained a high proportion of the vari-ance in depressive symptoms in both genders; 34.1% in boys and 36.8% in girls. The psycho-social level contributed the most to explaining the variance in depressive symptoms in boys. In girls, when harassment variables were separated from psychosocial variables, the harassment var- iables contributed as much to the full model as the rest of the psychosocial variables combined. Conclusions: Addressing psychosocial determi-nants provides the greatest benefits for prevent-ing depressive symptoms in adolescents. Ac-knowledging the association between sexual harassment and depressive symptoms for girls and having less money than their friends for boys and girls are particularly important.

Place, publisher, year, edition, pages
Irvine, CA: Scientific Research Publishing, 2012. Vol. 4, no 10, 881-889 p.
Keyword [en]
Mental health, Individual determinants, psychosocial determinants, structural determinants, socioeconomic factors, gender, harassment, social support, school, adolesence
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:miun:diva-17303DOI: 10.4236/health.2012.410134OAI: oai:DiVA.org:miun-17303DiVA: diva2:564167
Available from: 2012-11-02 Created: 2012-11-01 Last updated: 2016-11-07Bibliographically approved
In thesis
1. Determinants of Depressive Symptoms in Adolescents: The Role of Sexual Harassment and Implications for Preventive Interventions
Open this publication in new window or tab >>Determinants of Depressive Symptoms in Adolescents: The Role of Sexual Harassment and Implications for Preventive Interventions
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Depression is considered the worldwide leading cause of illness and disability in young people and an urgent public health issue. Within the field of public health it is of interest to deepen the understanding of determinants of depressive symptoms (DS) that are possible to address on a political or an organizational level. Also, it is of great importance to find methods to prevent depression in adolescents. To address these issues, the present thesis had two Aims: I) To study determinants of DS in adolescents, and II) to, by means of a non-randomized pragmatic trial evaluation, investigate the effectiveness a cognitive-behavioral intervention (DISA) in a real-world setting in relation to determinants of DS in adolescent girls. This was addressed by asking a) Which determinants on individual, psychosocial and structural levels are associated with DS in adolescents? (Paper I); b) What are the directional pathways between sexual harassment (SH) and DS? (Paper II); c) Which features characterize students who were assigned to a cognitive-behavioral intervention regarding levels of DS, psychosocial aspects and socioeconomic status of the respondents as well as of schools? (Paper III); d) Does DISA have an effect on DS in girls aged 14-16? (Paper IV); and e) Are there differences between the DISA participants and non-participants in the effects of psychosocial and structural determinants on DS? (Paper IV). Method: Data was collected in January 2010, 2011, and 2012, by means of a self-administered, electronic questionnaire in school. Students aged 14-16 in all nine public and one independent high school in a municipality in northern Sweden participated in the study (~1,000-1,200 students depending on the wave). All studies had DS as the single outcome variable. Individual level determinants were self-esteem and self-efficacy. Psychosocial determinants were parental/peer/teacher support; school demands; sexual harassment; and bullying. Structural determinants were family material affluence; parental foreign background, parental employment status; disrupted family, and personal relative affluence. Logistic regression was employed for research question a) (Paper I). Structural equation (SEM) cross-lag models were modeled for research question b) (Paper II). The Mann-Whitney U statistic was employed for research question c) (Paper III). SEM was used for research questions d-e) (Paper IV). Results: Determinants on individual, psychosocial and structural levels were independently associated with depressive symptoms in both genders. Self-efficacy, low teacher support, bullying victimization, and low personal relative affluence was associated with elevated levels of DS in both genders (Paper I). In girls, low parental support, high school demands, and sexual harassment victimization (SH) were also associated with elevated levels of DS. Among boys, parental migrant background was also associated with DS. Among girls, both the targeting of girls with elevated DS, and the consequence of SH explained the relationship between DS and SH victimization over time. In boys, only the predating of DS explained the association between DS and SH (Paper II). Only girls were assigned to DISA during 2011 and DISA participants reported higher levels of DS and lower levels of self-esteem than the non-participants at pre-intervention, which indicates that DISA was used as a targeted intervention for girls with elevated symptoms. Also, DISA participants reported higher levels of SH victimization, less peer support, and lower personal relative affluence (Paper III). In contrast to the non-participants, DISA participants did not increase their mean scoring on DS at an eight months follow-up. However, SEM analyses showed that the effect of DISA participation on DS at follow-up was negligible (Paper IV). Conclusions: This study showed that SH victimization was an important determinant for DS in girls followed by personal relative affluence. Among boys, personal relative affluence and parental migrant background were the most important factors. SH victimization had mental health consequences in girls only. DISA was implemented as a targeted intervention rather than as selective or universal one, and did not have an effect on DS in this group of girls. Implications for further research and health promotion practice in the school setting are discussed.

Abstract [sv]

Bakgrund: Depression anses vara den världsledande orsaken till sjukdom och funktionsnedsättning hos unga människor och en av de viktigaste folkhälsofrågorna gällande ungdomar. Inom folkhälsoområdet är det viktigt att fördjupa förståelsen av bestämningsfaktorer för depressiva symtom (DS) som är möjliga att ta itu med på en politisk eller organisatorisk nivå. Det är också av stort intresse att finna metoder för att förebygga depression hos ungdomar. För att adressera detta hade denna avhandling två Syften: I) Att studera bestämningsfaktorer för DS hos ungdomar 14-16 år, och II) Att genom en icke-randomiserad pragmatisk utvärderingsstudie undersöka effekten av en kognitiv beteendemodifierande intervention (DISA) så som den implementerats i praktiken i skolan i förhållande till bestämningsfaktorer för DS hos flickor. Följande frågeställningar formulerades: a) Vilka bestämningsfaktorer på individ, psykosocial och strukturell nivå är förknippade med DS hos ungdomar? (Paper I); b) I vilken riktning går sambandet mellan sexuella trakasserier (ST) och DS? (Paper II); c) Vad karaktäriserar elever som gått en kognitiv beteendemodifierande metod (DISA) avseende nivåer av DS, psykosociala aspekter och respondenternas och skolornas socioekonomiska status? (Paper III); d) Har DISA en effekt på DS hos flickor i åldern 14-16? (Paper IV); och e) Fanns det skillnader mellan DISA-deltagare och icke-deltagare avseende effekterna av psykosociala och strukturella faktorer på DS? (Paper IV). Metod: Data samlades in i januari 2010, 2011 och 2012 med hjälp av en självadministrerad, elektronisk enkät i skolan. Elever i åldrarna 14-16 i samtliga nio kommunala skolor och i en friskola i en kommun i norra Sverige deltog i studien (~1000-1200 elever beroende på datainsamlingsår). Samtliga studier hade DS som enda hälsoutfall. Individfaktorer som antogs ha samband med DS var självkänsla och upplevd förmåga att hantera problem i livet. Psykosociala faktorer var föräldra-, kamrat-, och lärarstöd; krav i skolan; sexuella trakasserier och mobbning. Strukturella faktorer var materiellt välstånd i familjen; föräldrar med utländsk bakgrund, föräldrars arbetslöshet; splittrad biologisk familj och personligt relativt välstånd. Logistisk regression användes för forskningsfråga a) (Paper I). Strukturell ekvationsmodellering (SEM) med en cross-lag design användes för forskningsfråga b) (Paper II). Mann-Whitney U test användes för forskningsfråga c) (Paper III). SEM användes för forskningsfrågorna d-e) (Paper IV). Resultat: Bestämningsfaktorer på individ-, psykosocial och strukturell nivå var associerade med DS hos båda könen. Upplevd förmåga att hantera problem i livet, lågt lärarstöd, utsatthet för mobbning, och lågt personligt relativt välstånd var associerat med förhöjda nivåer av DS för både pojkar och flickor (Paper I). Bland flickor var dessutom lågt föräldrastöd, höga krav i skolan, och utsatthet för sexuella trakasserier (ST) också associerade med förhöjda nivåer av DS och hos pojkar var även föräldrars invandrarbakgrund associerat med DS. Bland flickor förklarades sambandet mellan DS och ST både av att flickor med förhöjda DS blev utsatta för ST, och av att ST ledde till senare DS. Hos pojkar var det endast att pojkar med DS blev utsatta för ST som förklarade sambandet (Paper II). Endast flickor deltog i DISA och de rapporterade högre nivåer av DS och lägre självkänsla än de som inte deltog, vilket tyder på att DISA användes som en riktad intervention för flickor med förhöjda symtom. DISA-deltagare rapporterade även högre nivåer av utsatthet för ST, lägre kamratstöd och lägre personligt relativt välstånd (Paper III). DISA-deltagarnas genomsnittliga nivå av DS hade inte försämrats vid åttamånadersuppföljningen vilket icke-deltagarnas nivåer hade. SEM-analysen visade dock att effekten av DISA-deltagande på DS vid uppföljning var försumbar (Paper IV). Slutsatser: Denna studie visade att utsatthet för SH var en viktig faktor för DS hos flickor, följt av lågt personligt relativt välstånd. Hos pojkar var lågt personligt relativt välstånd den viktigaste bestämningsfaktorn följt av föräldrarnas invandrarbakgrund. Utsatthet för ST hade konsekvenser för psykisk ohälsa för flickor men inte för pojkar. DISA genomfördes som en riktad intervention snarare än som en selektiv eller universell intervention och hade inte en effekt på DS i denna grupp av flickor. Implikationer för fortsatt forskning samt för hälsofrämjande arbete i skolan diskuteras.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University, 2016. 108 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 254
Keyword
Depressive symptoms, Adolescence, School, Public Health, Sexual harassment, Personal relative affluence, Gender theory, Ecosocial theory, Cognitive-behavioral, Preventive interventions
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:miun:diva-27565 (URN)978-91-88025-91-3 (ISBN)
Public defence
2016-12-02, E409, Sundsvall, 10:00 (Swedish)
Opponent
Supervisors
Note

Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 4 manuskript.

At the time of the doctoral defence the following papers were unpublished: paper 4 manuscript.

Available from: 2016-11-07 Created: 2016-04-29 Last updated: 2016-11-07Bibliographically approved

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