Open access peer-reviewed chapter
Measures and variables under study.
Abstract
COVID-19 pandemic had a negative impact on adolescents’ psychological health. Two national studies were conducted. The DGEEC study included 9 to 18-year-old pupils. The HBSC study (2 waves) included pupils from the 6th, 8th, 10th, 12th grades. For each study, two groups were established based on life satisfaction scores and on psychological symptoms scores, producing four groups. In both studies, the group with high life satisfaction and reduced psychological symptoms had more boys and younger pupils. The group with low life satisfaction and pronounced psychological symptoms comprised more girls and older pupils. In the DGEEC Study, pupils with low life satisfaction and pronounced psychological symptoms were more likely to exhibit other unwellness signs. In the HBSC study, from 2018 to 2022 (with the COVID-19 in between), psychological symptoms increased significantly and life satisfaction decreased, exacerbating inequities. This model allowed to examine the results of DGEEC and HBSC studies under a new perspective comprising four scenarios, offering an innovative viewpoint on adolescents’ psychological health. Results also suggest a potential buffering effect of being physically active, adequate sleep, and adequate screen time. This is a powerful message for health and education professionals and policymakers regarding the relevance of health education and promotion.
Keywords
- pupils
- gender
- life satisfaction
- psychological symptoms
- lifestyles
- school
- quality of life perception
- COVID-19
1. Introduction
The vulnerabilities associated with the pandemic of COVID-19 have motivated studies reflecting on adolescents, including their physical and psychological health, either through their research or systematic analysis of documents produced by educational and health institutions and researchers [1, 2, 3, 4, 5, 6].
There is an agreement in the research about the psychosocial effects of the COVID-19 pandemic on school-aged children and adolescents [7]. Young people reported feeling more lonely and having more depression and anxiety symptoms [8]. Quantitative studies done all over Europe [9, 10, 11, 12] confirm this link and show an increase in symptoms of depression, anxiety, and stress.
Tomé and colleagues [13] argue that given the contingencies grounded in the pandemic by COVID-19 (more specifically, social distancing and general confinement/lockdown of the population), young people’s psychosocial contexts are considered to have undergone changes that, in turn, generated risks to their psychological health and life satisfaction [3, 10, 12, 14, 15].
The Dual Factor Model [16, 17, 18], was used, with some adaptations for its use in population studies, to understand the psychological health of children and adolescents and the associations with their lives and well-being. This model is here referred as “the quadripartite model”, as we retained from this model that life satisfaction and psychological symptoms are not opposed in a continuum of two dimensions, but rather four psychological states: Complete Psychological Health (reduced psychological symptoms and high life satisfaction), Incomplete Psychological Health (reduced psychological symptoms and low life satisfaction), Incomplete Psychological Distress (marked psychological symptoms and increased life satisfaction), and Complete Psychological Distress (marked psychological symptoms and low life satisfaction). Complete Psychological Health implies both conditions: high life satisfaction and reduced psychological symptoms, as suggested in the Dual Factor Model [16, 17, 18].
To test this model, data from two national studies, the Directorate-General of Education and Science Statistics of the Ministry of Education and the Ministry of Science (DGEEC), and the Health Behaviour in School-aged Children (HBSC) studies, were used for specific analyses. Gender and grade differences (a proxy for age differences) were confirmed in the four groups (complete and incomplete, health and distress). The DGEEC study also analysed how the situation changes with the perception of quality of life and three health behaviours/lifestyles. Considering HBSC, the differences between the 2018 wave (pre-COVID-19 pandemic) and the 2022 wave (post-COVID-19 pandemic) were analysed.
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2. STUDY 1: the DGEEC study
2.1 Methods
2.1.1 Procedures
The
Schools and classes were chosen randomly from a national list, and all the ethical procedures, authorisations, and anonymous and voluntary participation were guaranteed. Questionnaires were administered online. Full details are in the final national report of the DGEEC study [4].
2.1.2 Participants
This study included 4444 pupils (
2.2 Instruments
The measures and variables under study are described in Table 1.
| Variables | Category/Items | Min & Max |
|---|---|---|
| Gender | Boy | |
| Girl | ||
| Age | — | Min = 9 & Max = 18 |
| Grade | From 5th to 12th | Min = 5 & Max = 12 |
| Cycle of studies | 2.° cycle | Min = 1 & Max = 2 |
| Lower and upper secondary education | ||
| Cantril—Life satisfaction (HBSC) [19] | 11-step ladder: “The top of the ladder is “10″ and represents the best possible life for you, the bottom of the ladder is “0″ and represents the worst possible life for you. Right now, where do you think you are on the ladder?” | 0 = worst possible to 10 = best possible |
| HBSC_WHO-5 | Total [20] HBSC Psychological symptoms (HBSC) [21, 22] | Sadness | 5 lower to 15 higher 1 to 5—Seldom or Never to every day |
| Irritability | ||
| Nervousness | ||
| Difficulty falling asleep | ||
| Extreme sadness | ||
| Physical Activity (HBSC) [21, 22] | In the past 7 days, how many days did you engage in physical activity for at least 60 minutes? | 0 to 7 days |
| Sleep (HBSC) [21, 22] | In general, how many hours do you sleep each night? | 0 to 10 or more hours |
| Screen time (HBSC) [21, 22] | In general, how many hours do you spend each day in front of a screen (TV, mobile phone, computer, tablet? | 0 to 10 or more hours |
Table 1.
2.3 Statistical analysis and main results
Two groups were created from the measurement of life satisfaction (low—50.3%; high—49.7%) and two groups were created from the evaluation of psychological symptoms (reduced—53.4%; and pronounced—46.6%). In both variables, the median was used as a cut-off point). The combination of four situations resulted in four groups: (1)
Age and gender differences and differences related to lifestyles and perceptions of quality of life were analysed through Chi-squares or ANOVAS. A significant level was set at
2.3.1 Gender and age differences
It was found that boys are significantly more frequent in the group with high life satisfaction and low psychological symptoms (
It was also found that younger pupils were significantly more frequent in the group
Overall, the percentage of girls reporting psychological symptoms is significantly higher than that of boys, even when they report high life satisfaction. Conversely, the percentage of boys reporting no psychological symptoms is significantly higher than that of girls, even when they report low life satisfaction.
Younger participants are more satisfied with life, whether or not they have pronounced psychological symptoms, and older participants are less satisfied with life, whether or not they have pronounced psychological symptoms.
2.3.2 Lifestyles/health behaviours and quality-of-life perception differences
Considering other indicators of psychological well-being (perceived quality of life) and health behaviours (sleep time adequacy, physical activity time, and screen time), the pattern described favours pupils in a state of
| N | M | SD | F | ||
|---|---|---|---|---|---|
| Days with 60 min of adequate physical activity | Incomplete Psychological Health | 741 | 3.34 | 1.90 | 39.89*** |
| Complete Psychological Distress | 1364 | 2.93 | 1.80 | ||
| Complete Psychological Health | 1478 | 3.69 | 1.89 | ||
| Incomplete Psychological Distress | 593 | 3.34 | 1.83 | ||
| Sleep (hours of sleep) | Incomplete Psychological Health | 738 | 7.79 | 1.12 | 210.64*** |
| Complete Psychological Distress | 1356 | 7.12 | 1.31 | ||
| Complete Psychological Health | 1457 | 8.24 | 1.07 | ||
| Incomplete Psychological Distress | 590 | 7.83 | 1.24 | ||
| Screen time (hours of screen time) | Incomplete Psychological Health | 737 | 4.62 | 2.39 | 78.16*** |
| Complete Psychological Distress | 1364 | 5.41 | 2.55 | ||
| Complete Psychological Health | 1471 | 4.00 | 2.35 | ||
| Incomplete Psychological Distress | 591 | 4.76 | 2.57 | ||
| HBSC_WHO-5 | Total Score (out of 5 to 15) | Incomplete Psychological Health | 778 | 15.28 | 4.28 | 885.87*** |
| Complete Psychological Distress | 1430 | 10.79 | 4.53 | ||
| Complete Psychological Health | 1561 | 18.81 | 3.99 | ||
| Incomplete Psychological Distress | 617 | 15.42 | 4.23 | ||
Table 2.
Psychological symptoms and life satisfaction, by days of physical activity, hours of sleep, screen time, quality of life—Analysis of variance between groups.
Note: ***
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3. STUDY 2—the HBSC study
3.1 Methods
3.1.1 Procedures
The HBSC study network integrated multiple countries in 2018 and 2022. In 2018, 44 countries participated; in 2022, 51 countries participated [22, 23, 24]. Participants constitute a representative sample for the school grades under study. Schools and classes were picked at random from a national list. All ethical procedures and permissions were in place, and participation was both anonymous and voluntary. Questionnaires were administered online. Full details with the final national report of the HBSC study in 2018 [22] and 2022 [23].
3.1.2 Participants
In 2018, 8215 pupils from the 6th (30.7%), 8th (33.7%), 10th (20.8%), and 12th (14.8%) grades participated, with 52.7% being female and a mean age of 14.36 (SD = 2.28). In 2022, 7649 pupils from the 6th (22.4%), 8th (25.4%), 10th (28.1%), and 12th (24.1%) grades responded, with 51.8% being female and a mean age of 15.05 (SD = 2.36). Therefore, considering the 2018 and 2022 HBSC studies, 15,750 pupils were included, 51.8% from the 2018 HBSC study wave and 48.2% from the HBSC 2022 wave, and 53.2% were female.
3.2 Instruments
The measures and variables under study are described in Table 3.
| Variables | Category/Items | Min & Max |
|---|---|---|
| Gender | Boy | |
| Girl | ||
| Age | — | Min = 10 & Max = 18 |
| Grade | 6th, 8th, 10th; 12th | Min = 1 & Max = 4 |
| Cantril—Life satisfaction (HBSC) [19] | 11-step ladder: “The top of the ladder is “10″ and represents the best possible life for you, the bottom of the ladder is “0″ and represents the worst possible life for you. Right now, where do you think you are on the ladder?” | 0 = worst possible to 10 = best possible |
| HBSC Psychological symptoms (HBSC) [21, 22] | Sadness | 1 to 5—Seldom or Never to every day |
| Irritability | ||
| Nervousness | ||
| Fear |
3.3 Statistical analysis and main results
Two groups were created from the measurement of life satisfaction (low—45.4%; high—54.6%), and two groups were created from the evaluation of psychological symptoms (reduced—47.5%; and pronounced—52.5%). In both variables, the median was used as a cut-off point). Four groups were obtained from the combination of the four situations: (1)
It was confirmed, as in the previous DGEEC 2022 study, that in the HBSC study (either in 2018 or in 2022), younger pupils and boys were significantly more frequent in the group of complete psychological health and older pupils and girls were significantly more frequent in the group of complete psychological distress. There was also an age/grade gradient, with the situation deteriorating as schooling progresses.
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4. Discussion
In this application of the Dual Factor Model [16, 17, 18], to a population study, it was found that the model helped to explain the distribution of pupils by each of the situations defined by the four conditions.
As observed in previous research, we discovered that, globally, girls present a more disadvantageous situation in terms of their psychological distress [1, 2, 19, 20, 22, 23, 25, 26]. Additionally, we discovered that, globally, older pupils present a more disadvantageous situation concerning their psychological distress [22]. In a study by Yoon et al. [27], it is reaffirmed that adolescents exhibit clear signs of psychological distress as they age, with this trend becoming more prevalent among girls.
The results indicate that, globally, girls are more likely to report symptoms, even when report high life satisfaction. Boys are more likely to report the absence of symptoms, even when they report low life satisfaction. Also, the youngest are the most likely to express life satisfaction, regardless of the presence or absence of pronounced psychological symptoms. The oldest report the lowest levels of life satisfaction, regardless of the presence or absence of pronounced psychological symptoms. This fact demonstrates the need, already mentioned by the original authors [16, 17, 18], to take into account not only the extreme situations of “complete health” and “complete distress” but also the situations in which only one of the situations occurs (reduced psychological symptoms and high life satisfaction or pronounced psychological symptoms with low life satisfaction) (Table 4).
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|
|
|
Finally, when considering other indicators of psychological well-being (perceived quality of life) and certain health behaviours (adequacy of sleep time, physical activity time, and screen time), we found that this pattern is repeated, favouring pupils in a state of
As suggested by other authors, this study confirms that for a state of complete psychological well-being, both the dimensions of life satisfaction and absence of psychological distress symptoms are essential [16, 17, 18]. These same authors suggest that there is a need to consider situations in which only one of the situations occurs (low psychological symptoms and high life satisfaction or pronounced psychological symptoms with low life satisfaction) is present, as results suggest they may be alert to the differential position of gender across educational levels. The data suggest that, throughout schooling, psychological symptoms are most pronounced in girls even when they refer to high life satisfaction, while in boys, there is a decrease in life satisfaction, even without pronounced psychological symptoms. That is, among girls, it is suggested that girls’ negative trend with age is from a status of Incomplete Psychological Distress to a Status of Complete Psychological Distress. In contrast, among boys, it is suggested that boys’ negative trend with age is from a status of Complete Psychological Health to a Status of Incomplete Psychological Health.
The significance of being physically active, sleeping an adequate number of hours, and using screens in a balanced and moderated manner are three promising ways to increase the odds for boys and girls to grow older in a state of
In the HBSC study from 2018 to 2022, not only did psychological symptoms increase significantly and life satisfaction decrease, but the gap between girls and boys and between the oldest and the younger seems to have worsened, increasing the health and well-being gap between gender and age groups/grades [22, 23].
Both DGEEC and HBSC studies have some limitations that should be considered. These are self-report studies with a cross-sectional design, which does not allow making inferences of causality. Despite these limitations, the selection of participants was randomised and stratified by administrative region and level of education, with a high number of participants.
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5. Conclusions
This quadripartite model allows us to delve deeper into the evolution of life satisfaction and perception of psychological symptoms of distress and look at gender and educational level (age) differences from a different perspective.
This four-scenario perspective provides relevant insight into the worsening of the psychological health of adolescents after the COVID-19 pandemic, accentuates the gender differences already identified, alerts in a more refined way to the gender and grade/age differences, and has already had an impact on the recommendations defined and on the ongoing prevention and promotion measures [4].
Several previous studies [1, 2], specifically the recent HBSC 2022 study [20] and the DGEEC 2022 study [4], emphasise the significance of the prevention of psychological distress and the promotion of psychological health and well-being among adolescents in the school contexts integrates the following.
References
- 1.
Matos MG. Adolescentes: as suas vidas, o seu futuro. Lisboa: Fundação Francisco Manuel dos Santos; 2020 - 2.
Matos MG. Adolescentes: tudo o que sempre quis saber sobre o que pensam, o que desejam e o que sentem. Lisboa: Oficina do Livro; 2022 - 3.
Matos MG, Ramalho S, Santos O, Pereira T. A saúde mental dos alunos e dos profissionais na escola: escolas como ecossistemas de bem-estar, saúde e aprendizagem. In: Miguéns M, editor. Estado da Educação: Conselho Nacional de Educação; 2021. pp. 332-341 - 4.
Matos MG, Branquinho C, Noronha C, Moraes B, Santos O, Carvalho M, et al. Saúde Psicológica e Bem-estar | Observatório de Saúde Psicológica e Bem-estar: Monitorização e Ação. Lisboa: DGEEC; 2022 - 5.
Matos MG, Wainwright T. COVID-19 and mental health in school-aged children and young people: Thinking ahead while preparing the return to school and to life “as usual”. The Psychologist. 2021; 4 (1):1-12. DOI: 10.33525/PPRJ.V4I1.105 - 6.
World Health Organization. Strengthening Mental Health Promotion. Geneva, Switzerland: World Health Organization; 2022 - 7.
Ludwig-Walz H, Dannheim I, Pfadenhauer L, Fegert J, Bujard M. Increase of depression among children and adolescents after the onset of the COVID-19 pandemic in Europe: A systematic review and meta-analysis. Child and Adolescent Psychiatry and Mental Health. 2022; 16 (1):109. DOI: 10.1186/s13034-022-00546-y - 8.
Branquinho C, Matos MG. More than one year surfing the waves of COVID-19… and now the vaccination: NA. Psico. 2021; 52 (3):e41303. DOI: 10.15448/1980-8623.2021.3.41303 - 9.
Daniunaite I, Truskauskaite-Kuneviciene I, Thoresen S, Zelviene P, Kazlauskas E. Adolescents amid the COVID-19 pandemic: A prospective study of psychological functioning. Child and Adolescent Psychiatry and Mental Health. 2021; 15 (1):45. DOI: 10.1186/s13034-021-00397-z - 10.
Koper N, Creemers H, van Dam L, Stams G, Branje S. Resilience, well-being and informal and formal support in multi-problem families during the COVID-19 pandemic. Child and Adolescent Psychiatry and Mental Health. 2022; 16 (1):103. DOI: 10.1186/s13034-022-00542-2 - 11.
Orgilés M, Francisco R, Delvecchio E, Espada J, Mazzeschi C, Pedro M, et al. Psychological symptoms in Italian, Spanish and Portuguese youth during the COVID-19 health crisis: A longitudinal study. Child Psychiatry & Human Development. 2022; 53 (5):853-862. DOI: 10.1007/s10578-021-01211-9 - 12.
Spencer A, Oblath R, Dayal R, Loubeau J, Lejeune J, Sikov J, et al. Changes in psychosocial functioning among urban, school-age children during the COVID-19 pandemic. Child and Adolescent Psychiatry and Mental Health. 2021; 15 (1):73. DOI: 10.1186/s13034-021-00419-w - 13.
Tomé G, Branquinho C, Cerqueira A, Matos MG. COVID-19, social distance and adolescents’ risk behaviours, well-being and life satisfaction: A proxy study drawn from HBSC study. Análisis y Modificación de Conducta. 2021; 47 :176. DOI: 10.33776/amc.v47i175.4912 - 14.
Branquinho C, Santos A, Ramiro L, Matos MG. #COVID#BACKTOSCHOOL: Qualitative study based on the voice of Portuguese adolescents. Journal of Community Psychology. 2021; 49 (7):2209-2220. DOI: 10.1002/jcop.22670 - 15.
Vries J, Horstmann K, Mussel P. Trajectories in life satisfaction before and during COVID-19 with respect to perceived valence and self-efficacy. Current Psychology. 2022; 12 :1-17. DOI: 10.1007/s12144-022-03829-x - 16.
Greenspoon P, Saklofske D. Toward an integration of subjective well-being and psychopathology. Social Indicators Research. 2001; 54 (1):81-108. DOI: 10.1023/A:1007219227883 - 17.
Keyes C. The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior. 2002; 43 :207-222. DOI: 10.2307/3090197 - 18.
Westerhof G, Keyes C. Mental illness and mental health: The two continua model across the lifespan. Journal of Adult Development. 2010; 17 (2):110-119. DOI: 10.1007/s10804-009-9082-y - 19.
Cantril H. The Pattern of Human Concerns. New Brunswick, NJ, USA: Rutgers University Press; 1965 - 20.
World Health Organization. Wellbeing Measures in Primary Health Care/the DEPCARE Project: Report on a WHO Meeting. Stockholm, Sweden: World Health Organization; 1998 - 21.
Inchley J, Currie D, Young T, Samdal O, Torsheim T, Auguston L, Barnekon V. Growing up unequal: gender and socioeconomic differences in young people’s health and well-being. Health Behaviour in School-aged Children (HBSC) study: international report from the 2013/2014 survey. World Health Organization (WHO) Regional Office for Europe. 2016 - 22.
Matos MG, Equipa Aventura Social. A Saúde dos Adolescentes Portugueses após a recessão. Relatório do estudo Health Behaviour in School Aged Children (HBSC) em 2018 (ebook). Lisboa; 2018 - 23.
Gaspar T, Guedes F, Cerqueira A, Matos MG, Equipa Aventura Social. A saúde dos adolescentes portugueses em contexto de pandemia. Relatório do estudo Health Behaviour in School Aged Children (HBSC) em 2022 (ebook). Lisboa; 2022. Available from: https://aventurasocial.com/dt_portfolios/a-saude-dos-adolescentes-portugueses-em-tempos-de-recessao-2018-2/ - 24.
Inchley J, Currie D, Budisavljevic S, Torsheim T, Jåstad A, Cosma A, Weber M. Spotlight on adolescent health and well-being. Findings from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey in Europe and Canada. World Health Organization (WHO) Regional Office for Europe; 2020 - 25.
Gaspar T, Cerqueira A, Branquinho C, Matos MG. Dimensions of social and personal skills in children and adolescents: Age and gender differences. International Journal of Development Research. 2018; 8 (1):18394-18400 - 26.
Gaspar T, Tomé G, Gómez-Baya D, Guedes F, Cerqueira A, Borges A, et al. O bem-estar e a saúde mental dos adolescentes portugueses. Revista de Psicologia da Criança e do adolescente. 2019; 10 (1):17-28 - 27.
Yoon Y, Eisenstadt M, Lereya ST, Deighton J. Gender difference in the change of adolescents’ mental health and subjective wellbeing trajectories. European Child & Adolescent Psychiatry. 2022; 2022 :1-10 - 28.
Matos MG, Branquinho C, Noronha C, Moraes B, Santos O, Carvalho M, Rodrigues N. Modelo quadripartido das relações entre satisfação com a vida e de mal-estar psicológico: potencial impacto nas políticas públicas. In: Matos MG, Branquinho C, Rodrigues N, coordinators. Saúde Psicológica e Bem-estar | Observatório de Saúde Psicológica e Bem-estar: Monitorização e Ação. DGEEC; 2023. p.Error: Reference source not found-251 - 29.
Li X, Buxton OM, Lee S, Chang AM, Berger LM, Hale L. Sleep mediates the association between adolescent screen time and depressive symptoms. Sleep Medicine. 2019; 57 :51-60 - 30.
Vandendriessche A, Chekiere A, Van Cauwenberg J, De Clercq B, Dhondt K, DeSmet A, et al. Does sleep mediate the association between school pressure, physical activity, screen time, and psychological symptoms in early adolescents? A 12-Country Study. International Journal of Environmental Research and Public Health. 2019; 16 (6):1072. DOI: 10.1007/s10804-009-9082-y