Territorial and social inequalities in mental distress and self-perceived health among schooled adolescents: a cross-sectional study in central Catalonia and Barcelona

Abstract

Despite being generally considered healthy, adolescence is a crucial period where health behaviours are established, which can impact future well-being. Factors such as social determinants, psychosocial variables, and risk behaviours play significant roles in determining general and mental health, with important gender differences. This article aims to study social inequalities in the prevalence of mental distress and poor self-perceived health of 14 to 18-year-old students schooled in Central Catalonia and Barcelona in the 2021-2022 academic year, separately for boys and girls.

Cross-sectional study using data from two surveys that monitor health and health behaviours in Central Catalonia (DESKcohort) and in Barcelona (FRESC survey) during the year 2021-2022. The final sample included 7,309 adolescents (51.8% were girls). Prevalence of mental distress and poor self-perceived health status were estimated stratifying by sex and according to different social determinants of health (independent variables): axes of inequality, psychosocial variables, and health behaviours. Poisson regression models with robust variance were calculated to analyse potential associations with independent variables.

Sex differences were observed, with girls having more than twice as much mental distress (42.0% vs. 18.7%, p < 0.001) and poorer self-perceived health status (15.6% vs. 6%, p < 0.001), compared to boys. Behavioural factors were more strongly linked to self-perceived health status than to mental distress. Axes of inequality, bullying victimization and problematic internet use were associated to both mental distress and poor self-perceived health status for boys and girls.

Adolescents' overall health is associated to factors such as gender, sexual orientation, migration status, socioeconomic position, bullying victimization, and problematic internet use. This study underscores the importance of taking a holistic approach when developing preventive and promotion strategies for adolescent health, addressing different levels of intervention while focusing on the most vulnerable populations.