Socioeconomic differences in the adolescent mental health time trend: what do we refer to?

Abstract

Abstract Background The long-term increase in adolescent internalizing mental health problems in many countries has raised the question of potential socioeconomic status (SES) differences in this trend. Inconsistencies in how SES and mental health are operationalized hamper this question to be addressed. We examined variation in the adolescent mental health trend across different SES groups using different ways of operationalizing SES and mental health. Methods We used six waves (1993-2013) of Swedish data from the Health Behaviour of School-aged Children (HBSC) study, an international repeated cross-sectional study. We used three proxy indicators of SES: an objective measure and two subjective measures (adolescents’ perceptions of their own and their family’s economic situation). The mental health indicator was psychosomatic symptoms. For each SES indicator, we analyzed the mental health trend using two standards of dividing SES subgroups (absolute vs. relative standard) and mental health (mean vs. top 90% cut-off score). Results The long-term trend of adolescent mental health varied by the SES indicator used. The objective SES measure did not differentiate mental health across different SES groups and the subjective measure of adolescents’ own economic situation did so in terms of the level but not the trend. The subjective measure of the family’s economic situation revealed SES gaps in mental health in terms of both the level and the trend. Conclusions Adolescents’ perceptions of their family’s economic situation has a greater discriminant value than the other SES measures to identify SES gaps in mental health in Sweden. Thus, the trend in adolescent mental health across different SES groups varies depending on how SES and mental health are operationalized. We call for efforts in other countries to report trends with varying measures of SES and mental health. This will help identify vulnerable groups in each country and facilitate well-informed international comparisons. Key messages This study shows that the long-term trend in adolescent mental health according to one’s SES may meaningfully differ depending on how SES and mental health are operationalized. This study calls for future studies in other countries for a more precise identification of vulnerable groups and for a facilitation of well-informed international comparison.