School pressure and psychosomatic complaints among Swedish adolescents: does physical activity play a buffering role?

Sammanfattning: Aim: The aim of the study was to explore the association between school pressure and psychosomatic health complaints and the potentially moderating effect of physical activity in a Swedish cohort of adolescents.Method: Cross-sectional data from the Swedish Health Behavior in School-aged Children (HBSC) survey of 2017/2018 was used, with participants aged 11-15 (n=3,745). The exposure was school pressure, which was measured with one question. The outcome was psychosomatic complaints, with information on the frequency of eight complaints which was added to an index. Physical activity was measured with one question. Covariates were gender, grade, and family affluence. First, Cross-tabulations with Chi squared tests were performed to examine patterns related to the exposure variable, school pressure and the covariates as well, and one- way ANOVA was used to explore the bivariate association between school pressure and psychosomatic complaints. Next, linear regression analyses were conducted to examine the association between school pressure and psychosomatic health complaints, with adjusted models including age, gender, familial socioeconomic status, and physical activity. Moderation was examined with a multiplicative interaction term which was evaluated with a Wald test, as well as with a combined variable of both school pressure and physical activity.  Results: The results suggest that higher levels of school pressure were significantly associated with higher levels of psychosomatic health complaints. The association persisted even after the adjustment for covariates. The interaction analyses did not present any moderating effect of physical activity. However, the combined variable analysis showed indications of a buffering effect: for students in the high school pressure group, those with low physical activity had more psychosomatic health complaints than those with high physical activity, the difference being statistically significant.  Conclusion: This study helps further the knowledge on how adolescents’ experiences of school pressure is associated with psychosomatic health complaints and how physical activity can buffer against this association. Suggestions on future research and important study strengths and limitations were discussed.  Keywords  School pressure, psychosomatic health complaints, physical activity, adolescents, moderation.