Previous research has shown inconsistent time trends in adolescent mental well-being, but potential underlying mechanisms for such trends are yet to be examined. This study investigates cross-national time trends in adolescent mental well-being (psychosomatic health complaints and life satisfaction) in mainly European countries and the extent to which time trends in schoolwork pressure explain these trends. Methods: Data from 915,054 adolescents from 36 countries (50.8% girls; mean age ¼ 13.54; standard deviation age ¼ 1.63) across five Health Behaviour in School-aged Children surveys (2002, 2006, 2010, 2014, and 2018) were included in the analyses. Hierarchical multilevel models estimated cross-national trends in adolescent mental well-being and schoolwork pressure. We also tested whether schoolwork pressure could explain these trends in mental well-being. Results: A small linear increase over time in psychosomatic complaints and schoolwork pressure was found. No change in life satisfaction emerged. Furthermore, there was large cross-country variation in the prevalence of, and trends over time in, adolescent mental well-being and IMPLICATIONS AND CONTRIBUTION

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

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

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

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

Background Suicide is the second leading cause of death for young people worldwide. A significant amount of suicide attempts is known to be unplanned, but research on unplanned attempts among adolescents is limited. As knowledge on the profile of unplanned suicide attempts is crucial for effective prevention efforts, this study aims to characterize and compare three suicide behaviour profiles among adolescents: planned attempts, unplanned attempts and ideation without attempt. Methods Data from the 2014 Luxembourgish Health Behaviour in School-aged Children study was used. 879 adolescents aged 12 to 18 years old are included in this study. Data was gathered using paper questionnaires. ANOVAs with Games-Howell post-hoc tests were conducted for 18 independent variables, using the suicide behaviour variable as the dependent variable. Results Unplanned attempters report higher levels of parental and classmate support (p < 0.01), fewer health complaints (p < 0.001), higher life satisfaction (p < 0.01) and a more positive body image (p < 0.01) than planned attempters and ideators. Unplanned and planned attempters are younger than ideators (p < 0.01) and report more substance use and physical fighting than ideators (p < 0.01). Conclusions Unplanned attempters report better health (behaviour) and more social support than planned attempters and ideators. Unplanned attempters and planned attempters have higher levels of risk behaviour than ideators. Prevention efforts should be mindful of similarities and differences between the behaviours, and identify and address at risk adolescents accordingly. Key messages Unplanned attempters have better health (behaviour) and more social support than planned attempters and ideators. Results are incorporated in the Luxembourgish national plan for suicide prevention.

Issue As suicide is the second leading cause of death for young people, WHO aims to reduce the suicide rate with 10% by 2020 worldwide. In Luxembourg, organization D’Ligue coordinates suicide prevention. Since suicide research has been carried out in the country for a few years only, data on adolescent suicidal ideation is lacking. Therefore, D’Ligue has contacted the Luxembourg team of the international Health Behaviour in School-aged Children (HBSC) study, to identify risk factors for suicide behaviour and derive recommendations from them. Description of the problem First, our practice partner wanted us to provide them with basic data on the suicidal ideation of adolescents: How many adolescents are suicidal and what are risk factors? Second, recommendations for practice should be derived from the results. To this end, the HBSC data (2014) of 5262 pupils aged 12-18 were analysed. Results 15.1% of adolescents thought about suicide last year and 7% attempted suicide. Of the 24 risk factors examined, 12 were found to be significant, with three being particularly important: multiple health complaints (OR: 1.3 for each health complaint, p < 0.001, CI: 1.18 - 1.33), lower life satisfaction (OR: 1.3 for the loss of each life satisfaction point, p < 0.001, CI: 1.17 - 1.33) and frequent physical fighting (OR: 2.4, p < 0.001, CI: 1.57 - 3.74). Lessons Risk factors for suicide behaviour known from research have been confirmed for Luxembourg. What is new is that the number of health complaints is the most important risk factor for Luxembourgish adolescents. Therefore, a list of 8 health complaints was validated as a screening tool for suicidal thoughts. In a further step, this tool could be used, for example, by school nurses. The HBSC data can be used to update the national suicide prevention plan. Main messages HBSC data are used to: update the Luxembourgish national plan for suicide prevention.investigate a screening tool for adolescents at risk for suicide.