Advertisement

International Journal of Public Health

, Volume 61, Issue 4, pp 505–512 | Cite as

Does self-efficacy mediate the association between socioeconomic background and emotional symptoms among schoolchildren?

  • Charlotte Meilstrup
  • Lau Caspar Thygesen
  • Line Nielsen
  • Vibeke Koushede
  • Donna Cross
  • Bjørn Evald Holstein
Original Article

Abstract

Objectives

Emotional symptoms are widespread among adolescents with the highest prevalence among lower socioeconomic groups. Less is known about why and how to reduce this inequality but personal control, e.g., self-efficacy may be crucial. This study examines whether self-efficacy is a mediator in the association between occupational social class (OSC) and emotional symptoms.

Methods

Data stem from the cross-sectional Health Behavior in School-aged Children-Methodology Development Survey 2012 (HBSC-MDS) conducted among 11–15-year old schoolchildren in two Danish municipalities. Participation rate was 76.8 % of 5165 enrolled schoolchildren, n = 3969.

Results

Low OSC is associated with higher odds of daily emotional symptoms and low selfefficacy. Schoolchildren with low self-efficacy have higher odds for daily emotional symptoms. We find a strong and statistically significant direct effect between low OSC and daily emotional symptoms (OR = 1.55, 95 % CI: 1.33; 1.84) and a borderline statistically significant indirect effect of self-efficacy [OR = 1.17 (0.99; 1.38)].

Conclusions

Socioeconomic inequality in emotional symptoms exists. This inequality is partly explained by socioeconomic inequality in self-efficacy. Promotion of personal competences like self-efficacy may reduce emotional symptoms among all socioeconomic groups, thereby reducing socioeconomic inequalities in emotional symptoms.

Keywords

Mental health Adolescents Socioeconomic inequality Self-efficacy Emotional symptoms Mediation analysis 

Notes

Acknowledgments

We would like to acknowledge the Nordea Denmark Foundation (02-2011-0122) for funding the Health Behavior in School-aged Children Study (HBSC) 2012. The funders have had no influence on study design, data collection, analyses, and interpretation of results or writing of the manuscript.

References

  1. Amone-P’Olak K, Burger H, Ormel J, Huisman M, Verhulst FC, Oldehinkel AJ (2009) Socioeconomic position and mental health problems in pre- and early adolescents: the TRAILS study. Soc Psychiatry Epidemiol 44:231–238CrossRefGoogle Scholar
  2. Bandura A (1997) Self-efficacy: the exercise of control. Worth Publishers, UKGoogle Scholar
  3. Bandura A (2006) Adolescent development from an agentic perspective. In: Pajares F, Urdan T (eds) Self-efficacy beliefs of adolescents. Information age publishing, GreenwichGoogle Scholar
  4. Barry MM (2009) Addressing the determinants of positive mental health: concepts, evidence and practice. Int J Ment Health Promot 11:4–17CrossRefGoogle Scholar
  5. Barry MM, Clarke AM, Jenkins R, Patel V (2013) A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC Public Health 13:835–853CrossRefPubMedPubMedCentralGoogle Scholar
  6. Boardman JD, Robert SA (2000) Neighborhood socioeconomic status and perceptions of self-efficacy. Soc Perspect 43:117–136CrossRefGoogle Scholar
  7. Bøe T, Øverland S, Lundervold AJ, Hysing M (2012) Socioeconomic status and children’s mental health: results from the Bergen Child Study. Soc Psychiatry Epidemiol 47:1557–1566CrossRefGoogle Scholar
  8. Christensen U, Krølner R, Nilsson CJ, Lyngbye PW, Hougaard CO, Nygaard E, Thielen K, Holstein BE, Avlund K, Lund R (2014) Addressing social inequality in aging by the Danish occupational social class measurement. J Aging Health 26:106–127CrossRefPubMedGoogle Scholar
  9. Cole SR, Hérnan MA (2002) Fallibility in estimating direct effects. Int J Epidemiol 31:163–165CrossRefPubMedGoogle Scholar
  10. Currie C, Zanotti C, Morgan A, Currie D, de Looze M, Roberts C, Samdal O, Smith ORF, Barnekow V (2012). Social determinants of health and well-being among young people. In: Health behaviour in school-aged children (HBSC) study: international report from the 2009/2010 survey. WHO Regional Office for Europe, CopenhagenGoogle Scholar
  11. Damsgaard MT, Holstein BE, Koushede V, Madsen KR, Meilstrup C, Nelausen MK, Nielsen L, Rayce SB (2014) Close relations to parents and emotional symptoms among adolescents: beyond socio–economic impact? Int J Public Health 59:721–726CrossRefPubMedGoogle Scholar
  12. Due P, Krølner R, Rasmussen M, Andersen A, Trab Damsgaard M, Graham H, Holstein BE (2011) Pathways and mechanisms in adolescence contribute to adult health inequalities. Scand J Public Health 39:62–78CrossRefPubMedGoogle Scholar
  13. Haugland S, Wold B (2001) Subjective health complaints in adolescence-reliability and validity of survey methods. J Adolesc 24:611–624CrossRefPubMedGoogle Scholar
  14. Jané-Llopis E, Anderson P, Stewart-Brown S, Weare K, Wahlbeck K, McDaid D, Cooper C (2011) Reducing the silent burden of impaired mental health. J Health Commun 16:59–74CrossRefPubMedGoogle Scholar
  15. Jerusalem M, Hessling JK (2009) Mental health promotion in schools by strengthening self-efficacy. Health education 129:329–341Google Scholar
  16. Jiang J, Vanderweele TJ (2015) When is the difference method conservative for assessing mediation? Am J Epidemiol 182:105–108CrossRefPubMedGoogle Scholar
  17. Kaufman JS, MacLehose RF, Kaufman S (2004) A further critique of the analytic strategy of adjusting for covariates to identify biologic mediation. Epidemiol Perspect Innov 1:4CrossRefPubMedPubMedCentralGoogle Scholar
  18. Keyfitz L, Lumley MN, Hennig KH (2013) The role of positive schema’s in child psychopathology and resilience. Cogn Ther Res 37:97–108CrossRefGoogle Scholar
  19. Lange T, Vansteelandt S, Bekaert M (2012) A Simple unified approach for estimating natural direct and indirect effects. Am J Epidemiol 176:190–195CrossRefPubMedGoogle Scholar
  20. Lien N, Friestad C, Klepp KI (2001) Adolescents’ proxy reports of parents’ socioeconomic status: how valid are they? J Epidemiol Community Health 55:731–737CrossRefPubMedPubMedCentralGoogle Scholar
  21. Marmot MG (2004) The status syndrome: how social standing affects our health and longevity. Owl Books, New YorkGoogle Scholar
  22. Mazur J, Malkowska-Szkutnik A, Tabak I (2014) Changes in family socio-economic status as predictors of self-efficacy in 13-year-old Polish adolescents. Int J Public Health 59:107–115CrossRefPubMedGoogle Scholar
  23. Moor I, Richter M, Ravens-Sieberer U, Ottova-Jordan V, Elgar FJ, Pförtner T (2015) Trends in social inequalities in adolescent health complaints from 1994 to 2001 in Europe, North America and Israel: the HBSC study. Eur J Pub Health 25:57–60CrossRefGoogle Scholar
  24. Muris P (2002) Relationships between self-efficacy and symptoms of anxiety disorders and depression in a normal adolescent sample. Pers Individ Differ 32:337–348CrossRefGoogle Scholar
  25. Nielsen L, Meilstrup C, Nelausen MK, Koushede V, Holstein BE (2015) Promotion of social and emotional competence—experiences from a mental health intervention applying a whole school approach. Health Education 115:339–356CrossRefGoogle Scholar
  26. Nordahl H, Krølner R, Páll G, Currie C, Andersen A (2011) Measurement of ethnic background in cross-national school surveys: agreement between students’ and parents’ responses. J Adolesc Health 49:272–277CrossRefPubMedGoogle Scholar
  27. Patel V, Flisher AJ, Hetrick S, McGorry P (2007) Mental health of young people: a global public-health challenge. Lancet 369:1302–1313CrossRefPubMedGoogle Scholar
  28. Pearl J (2009) Causality: models, reasoning, and inference. Cambridge University Press, New YorkCrossRefGoogle Scholar
  29. Petersen MA, Groenvold M, Bjorner JB, Aaronsen N, Conroy T, Cull A, Fayers P, Hjermstad M, Sprangers M, Sullivan M (2003) Use of differential item functioning analysis to assess the equivalence of translations of a questionnaire. Qual Life Res 12:373–385CrossRefPubMedGoogle Scholar
  30. Petersen ML, Sinisi SE, van der Laan MJ (2006) Estimation of direct causal effects. Epidemiology 17:276–284CrossRefPubMedGoogle Scholar
  31. Ravens-Sieberer U, Erhart M, Torsheim T, Hetland J, Freeman Danielson M, Thomas C, The HBSC Positive Health Group (2008) An international scoring system for self-reported health complaints in adolescents. Eur J Public Health 18:294–299CrossRefPubMedGoogle Scholar
  32. Reiss F (2013) Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc Sci Med 90:24–31CrossRefPubMedGoogle Scholar
  33. Schwarzer R (1992) Self-efficacy. Thought control of actions, RoutledgeGoogle Scholar
  34. Schwarzer R, Jerusalem M (1995) Generalized self-efficacy scale. In: Weinman J, Wright S, Johnston M (eds) Measures in health psychology: a user’s portfolio. Causal and control beliefs. NFERNELSON, Windsor, UK, pp 35–37Google Scholar
  35. Stansfeld SA, Clark C, Rodgers B, Caldwell T (2008) Childhood and adulthood socio-economic position and midlife depressive and anxiety disorders. Br J Psychiatry 192:152–153CrossRefPubMedGoogle Scholar
  36. Steca P, Abela JRZ, Monzani D, Greco A, Hazel NA, Hankin BL (2014) Cognitive vulnerability to depressive symptoms in children: the protective role of self-efficacy beliefs in a multi-wave longitudinal study. J Abnorm Child Psychol 42:137–148CrossRefPubMedPubMedCentralGoogle Scholar
  37. Tahmassian K, Moghadam NJ (2011) Relationship between self-efficacy and symptoms of anxiety, depression, worry and social avoidance in a normal sample of students. Iran J Psychiatry Behav Sci 5:91–97PubMedPubMedCentralGoogle Scholar
  38. Vereecken C, Vandegehuchte A (2003) Measurement of parental occupation: agreement between parents and their children. Arch Public Health 61:141–149Google Scholar
  39. Weare K, Nind M (2011) Mental health promotion in schools: what does the evidence say? Health Promot Int 26:i29–i69CrossRefPubMedGoogle Scholar
  40. Wells J, Barlow J, Stewart-Brown S (2003) A systematic review of universal approaches to mental health promotion in schools. Health Educ 103:197–220CrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health (SSPH+) 2016

Authors and Affiliations

  • Charlotte Meilstrup
    • 1
  • Lau Caspar Thygesen
    • 1
  • Line Nielsen
    • 1
  • Vibeke Koushede
    • 1
  • Donna Cross
    • 2
  • Bjørn Evald Holstein
    • 1
  1. 1.National Institute of Public HealthUniversity of Southern DenmarkCopenhagen KDenmark
  2. 2.Telethon Kids InstituteSubiacoAustralia

Personalised recommendations