Risk and protective factors for psychological distress among adolescents: a family study in the Nord-Trøndelag Health Study

  • Ingri MyklestadEmail author
  • Espen Røysamb
  • Kristian Tambs
Original Paper



The study aimed to investigate potential adolescent and parental psychosocial risk and protective factors for psychological distress among adolescents and, in addition, to examine potential gender and age differences in the effects of risk factors on adolescent psychological distress.


Data were collected among 8,984 Norwegian adolescents (13–19 years) and their parents in the Nord-Trøndelag Health Study (HUNT). The outcome measure was psychological distress (SCL-5).


Bivariate regression analysis with generalized estimating equation (GEE) model showed that all parental self-reported variables (mental distress, substance use, social network, economic problems, unemployment and family structure) and adolescents’ self-reported variables (leisure activities, social support from friends, school-related problems and substance use) were significantly associated with psychological distress among adolescents. Results revealed that in a multiple regression analysis with a GEE model, adolescent psychosocial variables, specifically academic-related problems and being bullied at school, emerged as the strongest predictors of psychological distress among adolescents after controlling for age, gender, and all parental and adolescent variables. The following psychosocial risk factors were significantly more important for girl’s psychological distress compared to boys: problems with academic achievement, conduct problems in school, frequency of being drunk, smoking, dissatisfaction in school, living alone and seen parents being drunk.


Academic achievement and being bullied at school were the psychosocial factors most strongly associated with psychological distress among adolescents. Parental factors had an indirect effect on adolescent psychological distress, through adolescents’ psychosocial factors.


Adolescence Psychological distress Psychosocial factors Risk factors School problems 



The Nord-Trøndelag Health Study (The HUNT Study), from which the data were made available, is a collaboration between HUNT Research Centre, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Nord-Trøndelag County Council and Norwegian Institute of Public Health. This study was supported by grants from the Research Council of Norway.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatry 40:57–87PubMedCrossRefGoogle Scholar
  2. 2.
    Angold A, Costello EJ, Erkanli A, Worthman CM (1999) Pubertal changes in hormone levels and depression in girls. Psychol Med 29:1043–1053PubMedCrossRefGoogle Scholar
  3. 3.
    Anthony JC, Petronis KR (1995) Early-onset drug use and risk of later drug problems. Drug Alcohol Depend 40:9–15PubMedCrossRefGoogle Scholar
  4. 4.
    Armstrong TD, Costello EJ (2002) Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity. J Consult Clin Psychol 70:1224–1239PubMedCrossRefGoogle Scholar
  5. 5.
    Avison WR, McAlpine DD (1992) Gender differences in symptoms of depression among adolescents. J Health Soc Behav 33:77–96PubMedCrossRefGoogle Scholar
  6. 6.
    Bartko WT, Eccles JS (2003) Adolescent participation in structured and unstructured activities: a person-oriented analysis. J Youth Adolescence 32:233–241CrossRefGoogle Scholar
  7. 7.
    Beardslee WR, Versage EM, Gladstone TR (1998) Children of affectively ill parents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 37:1134–1141PubMedCrossRefGoogle Scholar
  8. 8.
    Cohen S, Wills TA (1985) Stress, social support, and the buffering hypothesis. Psychol Bull 98:310–357PubMedCrossRefGoogle Scholar
  9. 9.
    Costello EJ, Erkanli A, Federman E, Angold A (1999) Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex. J Clin Child Adolesc Psychol 28:298–311CrossRefGoogle Scholar
  10. 10.
    Dalgard OS, Dowrick C, Lehtinen V, Vazquez-Barquero JL, Casey P, Wilkinson G, Ayuso-Mateos JL, Page H, Dunn G (2006) The ODIN Group. Negative life events, social support and gender difference in depression. A multinational community survey with data from the ODIN study. Soc Psychiatry Psychiatr Epidemiol 41:444–451PubMedCrossRefGoogle Scholar
  11. 11.
    Dempster AP, Laird NM, Rubin DB (1977) Maximum likelihood from incomplete data via the EM algorithm. J Royal Stat Soc Ser B (Methodol) 39:1–38Google Scholar
  12. 12.
    Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L (1974) The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci 19:1–15PubMedCrossRefGoogle Scholar
  13. 13.
    Dolcini MM, Adler NE, Lee P, Bauman KE (2003) An assessment of the validity of adolescent self-reported smoking using three biological indicators. Nicotine Tobacco Res 5:473–483Google Scholar
  14. 14.
    Ewing JA (1984) Detecting alcoholism: the CAGE questionnaire. JAMA 252:1905–1907PubMedCrossRefGoogle Scholar
  15. 15.
    Froyd SA, Nissinen ES, Pelkonen MUI, Marttunen MJ, Koivisto AM, Kaltiala-Heino R (2008) Depression and school performance in middle adolescent boys and girls. J Adolesc 31:485–498CrossRefGoogle Scholar
  16. 16.
    Ganster DC, Hennessey HW, Luthans F (1983) Social desirability response effects: three alternative models. Acad Manage J 26:321–331CrossRefGoogle Scholar
  17. 17.
    Goldberg DP (1972) The detection of psychiatric illness by questionnaire: a technique for the identification and assessment of nonpsychotic psychiatric illness. Oxford University Press, OxfordGoogle Scholar
  18. 18.
    Hankin BL, Abramson LY, Moffitt TE, Silva PA, McGee R, Angell KE (1998) Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study. J Abnorm Psychol 107:128–140PubMedCrossRefGoogle Scholar
  19. 19.
    Hardin JW, Hilbe JM (2003) Generalized estimating equations. Chapman & Hall/CRC, Boca RatonGoogle Scholar
  20. 20.
    Helsen M, Vollebergh W, Meeus W (2000) Social support from parents and friends and emotional problems in adolescence. J Youth Adolesc 29:319–335CrossRefGoogle Scholar
  21. 21.
    Hirsch BJ, DuBois DL (1992) The relation of peer social support and psychological symptomatology during the transition to junior high school: a 2-year longitudinal analysis. Am J Community Psychol 20:333–347PubMedCrossRefGoogle Scholar
  22. 22.
    Jessor R, Jessor SL (1977) Problem behavior and psychosocial development. Academic Press, New YorkGoogle Scholar
  23. 23.
    Kapi A, Veltsista A, Kavadias G, Lekea V, Bakoula C (2007) Social determinants of self-reported emotional and behavioral problems in Greek adolescents. Soc Psychiatry Psychiatr Epidemiol 42:594–598PubMedCrossRefGoogle Scholar
  24. 24.
    Kendler KS, Gardner CO, Prescott CA (2002) Toward a comprehensive developmental model for major depression in women. Am J Psychiatry 159:1133–1145PubMedCrossRefGoogle Scholar
  25. 25.
    Kendler KS, Gardner CO, Prescott CA (2006) Toward a comprehensive developmental model for major depression in men. Am J Psychiatry 163:115–124PubMedCrossRefGoogle Scholar
  26. 26.
    Kessler RC, Avenevoli S, Ries Merikangas K (2001) Mood disorders in children and adolescents: an epidemiologic perspective. Biol Psychiatry 49:1002–1014PubMedCrossRefGoogle Scholar
  27. 27.
    Krueger RF (1999) The structure of common mental disorders. Arch Gen Psychiatry 56:921–926PubMedCrossRefGoogle Scholar
  28. 28.
    Liang KY, Zeger SL (1986) Longitudinal data analysis using generalized linear models. Biometrika 73:13–22CrossRefGoogle Scholar
  29. 29.
    Mahoney JL, Stattin H (2000) Leisure activities and adolescent antisocial behavior: the role of structure and social context. J Adolesc 23:113–127PubMedCrossRefGoogle Scholar
  30. 30.
    Mensah FK, Kiernan KE (2010) Parents’ mental health and children’s cognitive and social development. Families in England in the Millennium Cohort Study. Soc Psychiatry Psychiatr Epidemiol 45:1023–1035PubMedCrossRefGoogle Scholar
  31. 31.
    Neighbors B, Kempton T, Forehand R (1992) Co-occurence of substance abuse with conduct, anxiety, and depression disorders in juvenile delinquents* 1. Addict Behav 17:379–386PubMedCrossRefGoogle Scholar
  32. 32.
    Nelder JA, Wedderburn RWM (1972) Generalized linear models. J Royal Stat Soc Ser A (General) 135:370–384CrossRefGoogle Scholar
  33. 33.
    Nosikov A, Gudex C (2003) Developing common instruments for health surveys. IOS Press, AmsterdamGoogle Scholar
  34. 34.
    Olweus D (2003) Social problems in school. In: Bremner JG, Slater A (eds) An Introduction to developmental psychology. Blackwell, Malden, Mass., pp 434–454Google Scholar
  35. 35.
    Olweus D (2005) A useful evaluation design, and effects of the Olweus Bullying Prevention Program. Psychol Crime Law 11:389–402CrossRefGoogle Scholar
  36. 36.
    Oppedal B (2003) Adolescent mental health in multi-cultural context. Department of Psychology, University of Oslo, [Oslo]Google Scholar
  37. 37.
    Petersen AC, Compas BE, Brooks-Gunn J, Stemmler M, Ey S, Grant KE (1993) Depression in adolescence. Am Psychol 48:155–168PubMedCrossRefGoogle Scholar
  38. 38.
    Poulin C, Hand D, Boudreau B, Santor D (2005) Gender differences in the association between substance use and elevated depressive symptoms in a general adolescent population. Addiction 100:525–535PubMedCrossRefGoogle Scholar
  39. 39.
    Rice F, Harold G, Thapar A (2002) The genetic aetiology of childhood depression: a review. J Child Psychol Psychiatry 43:65–79PubMedCrossRefGoogle Scholar
  40. 40.
    Richter L, Richter DM (2001) Exposure to parental tobacco and alcohol use: effects on children’s health and development. Am J Orthopsychiatry 71:182–203PubMedCrossRefGoogle Scholar
  41. 41.
    Sandanger I, Nygård JF, Sørensen T, Moum T (2004) Is women’s mental health more susceptible than men’s to the influence of surrounding stress? Soc Psychiatry Psychiatr Epidemiol 39:177–184PubMedCrossRefGoogle Scholar
  42. 42.
    Scott WD, Dearing E, Reynolds WR, Lindsay JE, Baird GL, Hamill S (2008) Cognitive self-regulation and depression: examining academic self-efficacy and goal characteristics in youth of a Northern Plains Tribe. J Res Adolesc 18:379–394CrossRefGoogle Scholar
  43. 43.
    Shaw SM, Kleiber DA, Caldwell LL (1995) Leisure and identity formation in male and female adolescents: a preliminary examination. J Leis Res 27:245–263Google Scholar
  44. 44.
    Strand BH, Dalgard OS, Tambs K, Rognerud M (2003) Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10, SCL-5 and MHI-5 (SF-36). Nordic J Psychiatry 57:113–118CrossRefGoogle Scholar
  45. 45.
    Størksen I, Røysamb E, Moum T, Tambs K (2005) Adolescents with a childhood experience of parental divorce: a longitudinal study of mental health and adjustment. J Adolesc 28:725–739PubMedCrossRefGoogle Scholar
  46. 46.
    Sullivan PF, Neale MC, Kendler KS (2000) Genetic epidemiology of major depression: review and meta-analysis. Am J Psychiatry 157:1552–1562PubMedCrossRefGoogle Scholar
  47. 47.
    Sund AM, Larsson B, Wichstrøm L (2003) Psychosocial correlates of depressive symptoms among 12–14-year-old Norwegian adolescents. J Child Psychol Psychiatry 44:588–597PubMedCrossRefGoogle Scholar
  48. 48.
    Søgaard AJ, Bjelland I, Tell GS, Røysamb E (2009) A comparison of the CONOR Mental Health Index to the HSCL-10 and HADS: measuring mental health status in The Oslo Health Study and the Nord-Trøndelag Health Study. Norwegian J Epidemiol 13:279–284Google Scholar
  49. 49.
    Tambs K (1994) A study of sexual abuse of children. Norwegian Institute of Public Health, OsloGoogle Scholar
  50. 50.
    Tambs K, Moum T (1993) How well can a few questionnaire items indicate anxiety and depression? Acta Psychiatr Scand 87:364–367PubMedCrossRefGoogle Scholar
  51. 51.
    Trainor S, Delfabbro P, Anderson S, Winefield A (2010) Leisure activities and adolescent psychological well-being. J Adolesc 33:176–186Google Scholar
  52. 52.
    Ttofi MM, Farrington DP (2009) What works in preventing bullying: effective elements of anti-bullying programmes. J Aggress Confl Peace Res 1:13–24CrossRefGoogle Scholar
  53. 53.
    Weissberg RP, Caplan M, Harwood RL (1991) Promoting competent young people in competence-enhancing environments: a systems-based perspective on primary prevention. J Consult Clin Psychol 59:830–841PubMedCrossRefGoogle Scholar
  54. 54.
    Wichstrom L (1999) The emergence of gender difference in depressed mood during adolescence: the role of intensified gender socialization. Dev Psychol 35:232–245PubMedCrossRefGoogle Scholar
  55. 55.
    Williams R, Christian J, Gay M, Gilvarry E (1996) Children and young people: substance misuse services; the substance of young needs. HMSO, LondonGoogle Scholar
  56. 56.
    Winefield AH (1993) Growing up with unemployment: a longitudinal study of its psychological impact. Routledge, LondonGoogle Scholar
  57. 57.
    Ystgaard M (1997) Life stress, social support and psychological distress in late adolescence. Soc Psychiatry Psychiatr Epidemiol 32:277–283PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Ingri Myklestad
    • 1
    Email author
  • Espen Røysamb
    • 2
    • 3
  • Kristian Tambs
    • 2
  1. 1.Division of Mental Health, Department of Children and AdolescentsNorwegian Institute of Public Health (NIPH)OsloNorway
  2. 2.Division of Mental HealthNorwegian Institute of Public Health (NIPH)OsloNorway
  3. 3.Department of PsychologyUniversity of OsloOsloNorway

Personalised recommendations