Self-reported health and social alienation in Swedish adolescents: A cross-sectional study among high-school students in Stockholm

Abstract: Background: Adolescents' health-damaging behaviors and social alienation of young people are recognized as public-health problems. One of the hypotheses that is emerging and evolving in the sociology, physiology, and health fields is that individuals with a great feeling of alienation are at risk of mental health problems and present negative health-risk behaviors. Objectives: This thesis aims to investigate the relationship between the feeling of social alienation and selfreported health. The first sub-study aims to provide an appropriate social alienation scale for use in the Swedish context and among adolescents. The second and third sub-studies aim to explore social alienation and the selfreported health status of Stockholm’s high-school students by examining the role of age, sex, and immigration background. The fourth sub-study investigates the relationship between self-reported health and the feeling of social alienation. The final sub-study investigates the relationship between the feeling of alienation and mental health by examining the role of socio-economic factors. Materials: The thesis is built around five articles through the analysis of data gathered with the Nottingham health profile (NHP) and the Jessor and Jessor social alienation scale. The data were collected from eight high schools in Stockholm, and the number of participants was 446 (age = 15–19; SD = 1.01; mean = 17). Results: The Jessor and Jessor alienation scale translated to Swedish and several validity methods such as translation and back-translation and face, content, and construct validity were used. A stability and interconsistency test was also performed to examine the reliability of the scale. The overall result of the abovementioned tests indicated that the Swedish version of the alienation scale is an adequate and valid questionnaire to use among adolescents (Article I). Age was found to be associated with the feeling of alienation and mental health, and students aged 17 demonstrated fewer mental-health problems and a lower feeling of alienation (Article II and V). Sex was shown to be one of the main significant variables in regard to self-reported health and contributes to a larger number of self-reported problems; also, female students reported more health problems than male students (Article III and V). These differences were much larger amongst immigrant students. Native Swedish females reported significantly more health problems about two aspects of health (energy level and emotional reaction) than native Swedish males, whereas the female students from an immigrant background reported significantly higher self-reported problems on other dimensions as well (isolation, physical mobility, and pain).The immigration background was found to be a significant variable in self-reported health and feeling of alienation (Article II, III, & V). Students with an immigrant background reported significantly more self-reported problems with sleep, pain, emotional reaction, and energy level (Article III). They also have larger health problems, in particular mental health problems (Article V). Students from non-Swedish parents (in particular from a Middle-Eastern origin) reported significantly more health problems in comparison with native Swedish students (Article V). Students with an immigrant background also significantly reported a stronger feeling of social alienation than Swedish natives, and the level of feeling of alienation was much higher among the first generation of immigrants (Article II). Neighborhood characteristics, such as home area and home type, were also found to be a significant variable on self-reported mental health. No significant differences about feeling of alienation and self-reported health were observed with respect to parents’ educational level (Article II &V). Finally, alienation was found as a mediating variable between selfreported mental health and self-reported physical health (Article IV & V). The more severe mental health problems are associated with a higher feeling of alienation, and the feeling of alienation is associated with selfreported physical health problems (Article IV & V). Conclusion: The results described in this thesis highlight that, in general, female students report more health problems than male students, and the contrast is larger among the students with an immigrant background. The finding shows that the feeling of alienation and self-reported health problems are higher among students with immigrant background, regardless of the country of origin, and self-reported health problems are higher among students from the Middle East. The results also indicate a strong association between the feeling of alienation and having more self-reported mental health problems; this suggests the mediating role of the feeling of alienation between mental health and physical health.