Adolescence is quite a sensitive development stage for managing resources, mental health, and health-related habits. For most young people, this is a healthy and happy experience, but for some it is emphasized by many social and health challenges [1
]. There is a general agreement in the literature that healthy adolescent development has its roots in multiple contexts.
Somatic complaints, especially headache, stomachache, backache, and morning fatigue are frequently reported among children and adolescents and often co-occur [1
]. Furthermore, multisite but not specific-site somatic complaints are more common among youth [9
] and pain symptoms become more prevalent with age [9
]. In many cases, it associates with behavioral [14
], somatic [16
], sociodemographic [11
], and social [14
Predominantly, the research shows that youth who are involved in contexts that provide positive resources from important people (for example, parents, schools, peers or communities), are not only less likely to experience negative outcomes but are more likely to show positive development and health-related behaviors as well [20
]. In line with these empirical findings, poor social support seems to be one of the possible predictors of subjective health complaints. With all potentially relevant external factors, psychosocial dimensions—perceived social and mental support from parents, teachers, and peers—often act as essential conditions and are strongly associated with young people’s behavior and health outcomes [23
]. In addition, social support may have both direct and indirect effects on health-related outcomes [29
Active support, especially from relatives, may be regarded as one of the most consistent predictors of health complaints [29
], while the teacher–student relations also associate with wellness [32
]. However, while parents are the most central source of support for young children, relational orientation changes tend to occur in adolescence, where peers also become more important [33
]. Studies show that peer support acts as a strong buffering resource, especially regarding health complaints, while the support from teachers and parents demonstrates moderating effects [33
School-related adolescent well-being is strongly associated with perceived aggressive behaviors [23
], which is quite prevalent in the school setting [20
]. Victims of bullying have significantly higher chances of developing new psychosomatic problems [37
]. Bullying is associated with several subjective health complaints, among them—headache, backache, abdominal pain and dizziness, fatigue, and sleep problems [5
]. Perceived social support plays an essential role as a protective factor against bullying and health complaints at the same time—higher parental warmth and support is associated with less involvement across all forms and classifications of bullying among adolescents [43
], while peers and friends also seem to play a very important though more mixed role [44
]. In the context of school, peers and teachers are more likely to be an essential part of a child’s social support network, providing social support in its many forms [43
The present study aimed (1) to describe and compare the prevalence of chronic specific-site (headache, backache, or stomach-ache) and multisite pain in adolescents; (2) to investigate the patterns of chronic pain by age and gender; (3) to examine effects on variations of chronic pain, and associations between pain and age; and (4) to explore how school-related context (relations with family, peers, and teachers; school demand, satisfaction and bullying) can be related to adolescents’ subjective health outcomes (specific-site and multisite pain).
It was found that, the most common subjective health complaint among respondents was a headache, being expressed among 17.2% of school children. Backache, headache, and stomachache were more common among girls than boys, but statistically significant difference was observed only for backache and stomachache (p
< 0.001). In most cases, the somatic complaints were expressed more in younger age, though in some cases it was inconsistent (Table 2
For wider comparisons, additionally, the three analyzed complaints were composed of one indicator—multisite complaint. This score ranged from 0 to 3, which indicated how many complaints a particular student experienced. It was found that multisite complaints were more common among girls than boys (on average, 20.6% and 12.3%; p
< 0.001) and were associated with age—students aged 13 and 15 years (on average, 17.2% and 19.2%, respectively) reported more complaints than 11 year-olds (on average, 13.1%; p <
0.001). The detailed information on the prevalence of the above-mentioned complaints is presented in Table 2
Social support was measured by considering three types of support—family, classmates, and teachers support (Table 3
). High family support was more expressed than the other support types. It can also be noted that high teacher support was usually more prevalent than classmate support. Classmates and teachers support were expressed more among boys, while family support—among girls. Almost all support types had decreasing trends with age.
For further analyses, social support was regarded as a total score composed of classmates, family, and teachers support (as overall social support score—OSSS). It was found that the highest prevalence of full social support (i.e., all three types of social support were high) was among 11 year-olds (42.6% of boys and 41.8% of girls). OSSS was strongly negatively associated with age—in the oldest cohort (15 year-olds) the perceived OSSS prevalence dropped twice (compared with 13 year-olds) in both genders.
Before the multiple regression, the potential predictor variables were checked for possible multicollinearity (Table 4
). The correlations were between weak and moderate.
The main result of this study was that the school-related factors and social support showed consistent associations with multisite somatic complaints in a representative sample of Lithuanian adolescents. The study demonstrated that school-related factors—bullying, school demand, satisfaction, and social support were significant and independent factors for somatic complaints among adolescents.
The similar effect of age and gender was identified in other studies. Previous research has shown that increasing age associates with a higher prevalence of a backache [10
], headache [10
], and stomach pain [64
]. In addition, we found that headache and stomach pain were more prevalent among girls than boys. This finding was in line with the previous studies suggesting that the female gender is stronger predictor of different pain symptoms [9
]; in addition, multisite pain was also more common among girls than specific-site pain [10
]. It is assumed that all biological, cultural, psychological, and social factors (such as pupil dilation, muscle reflexes, differences in cerebral activation or exception, expression, and tolerance of pain, etc.) might contribute to these disparities between males and females regarding the pain responses and management [9
]. Sex hormones play an important role and influence pain sensitivity—pain threshold and pain tolerance in women vary with the stage of the menstrual cycle [17
]. Puberty also plays an important role—in early stage, the expression of pain complaints is similar among girls and boys, but as puberty progresses, one or more common pain complaints increase more dramatically in girls [9
]. Psychosocial differences in the perception, expression, and tolerance of pain are likely influenced by a variety of social and psychological processes [9
]. For example, pain catastrophism might explain gender-based differences in the reporting of certain types of pain, with women tending to resort to more hyperbolics [18
], or male gender norm dictating increased tolerance of pain among males [68
Our study results revealed that social support contributed to better somatic outcomes, where high family and teacher support might have acted as strong protective factors against somatic complaints. The importance of family and teacher support for adolescent’s somatic complaints and well-being was widely confirmed in previous studies [29
]. Interestingly, our results showed that the type of perceived school-related social support differed between the genders—for boys, support from classmates and teacher was most important, while for girls, family support was the strongest protecting type of support. The prominence of each support source could be based on a variety of cultural, ethical, socialization, or personality factors. During early adolescence, due to biological, psychological, and social role changes, boys are more likely to show problematic behavior that draws attention from teachers, thus, their comprehensive support becomes more important (boys and girls seem to receive differential treatment from teachers) [46
]. More specifically, girls might value relational intimacy in a different way or to a different degree than boys, which is possibly why parents’ support becomes more important. Helsen et al. (2000) noted that shifts from family support to peer support occur more gradually in boys than girls, which means that relationships with classmates become more and more essential for boys as they mature [69
Our study found a consistent relationship of somatic complaints with bullying. Bullying perpetration was mostly associated with all types of subjective somatic complaints in all age and gender groups. This pattern was found in other studies, where bullying perpetration is considered as the most essential factor for adolescent somatic outcomes [5
]. Furthermore, these studies showed that bullying has serious long-term effects on health and well-being later in life—childhood psychiatric disorders (including conduct disorder, hyperactivity disorder, attention deficit, or oppositional defiant disorder) [42
], backache, headache, fatigue, abdominal pain, dizziness, and sleep problems [5
]. Involvement with bullying in any role is a very strong predictor of negative health, risk behavior (smoking, drinking, drug usage, long-term illness, depression, psychiatric problems, etc.) [42
], and social outcomes (illegal behaviors) in later adulthood [42
To conclude, our study indicated that somatization was affected by quite a wide range of school-related factors, where all types of school contents (bullying, school-related demand and support, and school satisfaction) played similarly important roles for the school children’s somatic outcomes. Adolescents with multisite pain were more likely to report impaired quality of life [12
] and higher levels of other health complaints like anxiety and depression [12
], which could further negatively affect the psychosocial development and daily functioning over time [14
]. This study extended the limited research in this area by analyzing not only a possible predictor of the expected outcomes, but also by reporting the likelihood of significant somatic complaints associated with school-related risk factors, as a complex.
When talking about the limitations of this study, it should be noted that self-reported somatic complaints might not always reflect the actual prevalence of this problem due to other important external factors—emotional background of adolescents during the data collection, different threshold of experienced health complaints, possibly blurred distinctions between health and illness, etc. In this study, we used the overall school-related social support in order to evaluate the total support in the learning environment of school children. This measure ranged from 0 to 3 and was limited in that it implied the same weight for all three types of support—teachers, peers, and parents, which might not be necessarily equal in their relevance. On the other hand, our data were based on a rich dataset that enabled the assessment of different aspects, not only of social support but of psychosomatic symptoms as well. Additionally, it should be noted that in our study, bullying perpetration was measured through questions, which were preceded by the definition of bullying [59
], but such aggression behavior experiences that were outside the scope of the bullying definition could also have been harmful [75
]. Therefore, it should be taken under consideration that HBSC bullying perpetration definition has not yet been validated as a direct measure of bullying, despite its wide usage in empirical studies across multiple countries. When talking about data analysis, multilevel modeling was not used, and it could also be considered as a limitation.