OBJECTIVES: It has been known that social environments are associated with adolescents' health. However, the complex relationship between diverse types of social environments and adolescents' psychosomatic heath remained unclear. Thus, using an ecological perspective, the current study aimed to examine the associations between social environment and adolescents' psychosomatic health. METHODS: We used the data from the Health Behavior in School-aged Children (HBSC) project conducted in the Czech Republic in 2018. A total of 13377 observations were included. RESULTS: The region, as a macrosystem, could not explain the variance in adolescents' psychological and somatic health. The quality of neighborhood environment (exosystem) was significantly related to adolescents' psychological and somatic health. At the microsystem level, teacher support had stronger, family support had weaker, and peer support had no association with psychological and somatic health. At the mesosystem level, the interactions between family, teacher, and friend support were negligible for adolescents' psychological and somatic health. CONCLUSIONS: The results underscore the importance of teachers' support and neighborhood environment for adolescents' psychosomatic health. Therefore, the findings suggest the need to improve teacher-adolescent relationships and the neighborhood community quality.

Department of Education Studies Academy of Future Education Xi'an Jiaotong Liverpool University Suzhou China

Department of Psychology Faculty of Social Studies Masaryk University Brno Czechia

Psychology Research Institute Faculty of Social Studies Masaryk University Brno Czechia

See more in PubMed

Åslund C., Starrin B., Nilsson K. W. (2010). Social capital in relation to depression, musculoskeletal pain, and psychosomatic symptoms: a cross-sectional study of a large population-based cohort of Swedish adolescents. BMC Public Health 10, 1–10. doi: 10.1186/1471-2458-10-715 PubMed DOI PMC

Barrera M., Chassin L., Rogosch F. (1993). Effects of social support and conflict on adolescent children of alcoholic and nonalcoholic fathers. J. Pers. Soc. Psychol. 64, 602–612. doi: 10.1037/0022-3514.64.4.602, PMID: PubMed DOI

Bliese P. D. (1998). Group size, ICC values, and group-level correlations: a simulation. Organ. Res. Methods 1, 355–373. doi: 10.1177/109442819814001 DOI

Blinka L., Šablatúrová N., Ševčíková A., Husarova D. (2020). Social constraints associated with excessive internet use in adolescents: the role of family, school, peers, and neighbourhood. Int. J. Public Health 65, 1279–1287. doi: 10.1007/s00038-020-01462-8, PMID: PubMed DOI

Brand S., Kirov R. (2011). Sleep and its importance in adolescence and in common adolescent somatic and psychiatric conditions. Int. J. Gen. Med. 4:425. doi: 10.2147/IJGM.S11557 PubMed DOI PMC

Bronfenbrenner U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.

Caldwell C. H., Wright J. C., Zimmerman M. A., Walsemann K. M., Williams D., Isichei P. A. C. (2004). Enhancing adolescent health behaviors through strengthening non-resident father–son relationships: a model for intervention with African-American families. Health Educ. Res. 19, 644–656. doi: 10.1093/her/cyg078, PMID: PubMed DOI

Chu P. S., Saucier D. A., Hafner E. (2010). Meta-analysis of the relationships between social support and well-being in children and adolescents. J. Soc. Clin. Psychol. 29, 624–645. doi: 10.1521/jscp.2010.29.6.624 DOI

Chung H. L., Docherty M. (2011). The protective function of neighborhood social ties on psychological health. Am. J. Health Behav. 35, 785–796. doi: 10.5993/AJHB.35.6.14, PMID: PubMed DOI

Chzhen Y., Moor I., Pickett W., Stevens G. (2016). Family affluence and inequality in adolescent health and life satisfaction: Evidence from the HBSC study 2002-2014 (Issues 2016–10). UNICEF Office of Research-Innocenti.

Currie C., Morgan A. (2020). A bio-ecological framing of evidence on the determinants of adolescent mental health-a scoping review of the international health behaviour in school-aged children (HBSC) study 1983-2020. SSM-population. Health 12:100697. doi: 10.1016/j.ssmph.2020.100697 PubMed DOI PMC

Damsgaard M. T., Holstein B. E., Koushede V., Madsen K. R., Meilstrup C., Nelausen M. K., et al. . (2014). Close relations to parents and emotional symptoms among adolescents: beyond socio-economic impact? Int. J. Public Health 59, 721–726. doi: 10.1007/s00038-014-0600-8, PMID: PubMed DOI

Due P., Damsgaard M. T., Madsen K. R., Nielsen L., Rayce S. B., Holstein B. E. (2019). Increasing prevalence of emotional symptoms in higher socioeconomic strata: trend study among Danish schoolchildren 1991–2014. Scand. J. Public Health 47, 690–694. doi: 10.1177/1403494817752520, PMID: PubMed DOI

Dusi P. (2012). The family-school relationships in Europe: a research review. CEPS J. 2, 13–33. doi: 10.26529/cepsj.393 DOI

Elgar F. J., De Clercq B., Schnohr C. W., Bird P., Pickett K. E., Torsheim T., et al. . (2013). Absolute and relative family affluence and psychosomatic symptoms in adolescents. Soc. Sci. Med. 91, 25–31. doi: 10.1016/j.socscimed.2013.04.030, PMID: PubMed DOI

Eminson D. M. (2007). Medically unexplained symptoms in children and adolescents. Clin. Psychol. Rev. 27, 855–871. doi: 10.1016/j.cpr.2007.07.007 PubMed DOI

Erdley C. A., Nangle D. W., Newman J. E., Carpenter E. M. (2001). Children’s friendship experiences and psychological adjustment: theory and research. New Dir. Child Adolesc. Dev. 2001, 5–24. doi: 10.1002/cd.3 PubMed DOI

Freeman J. G., Samdal O., Băban A., Bancila D. (2012). The relationship between school perceptions and psychosomatic complaints: cross-country differences across Canada, Norway, and Romania. Sch. Ment. Heal. 4, 95–104. doi: 10.1007/s12310-011-9070-9 DOI

Friberg P., Hagquist C., Osika W. (2012). Self-perceived psychosomatic health in Swedish children, adolescents and young adults: an internet-based survey over time. BMJ Open 2:e000681. doi: 10.1136/bmjopen-2011-000681, PMID: PubMed DOI PMC

Gariepy G., McKinnon B., Sentenac M., Elgar F. J. (2016). Validity and reliability of a brief symptom checklist to measure psychological health in school-aged children. Child Indic. Res. 9, 471–484. doi: 10.1007/s12187-015-9326-2 DOI

Gubbels J. S., Van Kann D. H. H., de Vries N. K., Thijs C., Kremers S. P. J. (2014). The next step in health behavior research: the need for ecological moderation analyses-an application to diet and physical activity at childcare. Int. J. Behav. Nutr. Phys. Act. 11, 1–11. doi: 10.1186/1479-5868-11-52 PubMed DOI PMC

Hagquist C. (2016). Family residency and psychosomatic problems among adolescents in Sweden: the impact of child-parent relations. Scand. J. Public Health 44, 36–46. doi: 10.1177/1403494815610664, PMID: PubMed DOI

Haugland S., Wold B. (2001). Subjective health complaints in adolescence—reliability and validity of survey methods. J. Adolesc. 24, 611–624. doi: 10.1006/jado.2000.0393, PMID: PubMed DOI

Haugland S., Wold B., Stevenson J., Aaroe L. E., Woynarowska B. (2001). Subjective health complaints in adolescence: a cross-national comparison of prevalence and dimensionality. Eur. J. Pub. Health 11, 4–10. doi: 10.1093/eurpub/11.1.4, PMID: PubMed DOI

Health Literacy Portal (2006). Health Literacy Portal. Available at: http://zdravotnigramotnost.cz/

Hendriks A. M., Bartels M., Stevens G., Walsh S. D., Torsheim T., Elgar F. J., et al. . (2020). National child and adolescent health policies as indicators of adolescent mental health: a multilevel analysis of 30 European countries. J. Early Adolesc. 40, 537–565. doi: 10.1177/0272431619858413 DOI

Hetland J., Torsheim T., Aarø L. E. (2002). Subjective health complaints in adolescence: dimensional structure and variation across gender and age. Scand. J. Public Health 30, 223–230. doi: 10.1177/140349480203000309, PMID: PubMed DOI

Higgins J. W., Begoray D., MacDonald M. (2009). A social ecological conceptual framework for understanding adolescent health literacy in the health education classroom. Am. J. Community Psychol. 44, 350–362. doi: 10.1007/s10464-009-9270-8, PMID: PubMed DOI

Hobza V., Hamrik Z., Bucksch J., De Clercq B. (2017). The family affluence scale as an indicator for socioeconomic status: validation on regional income differences in the Czech Republic. Int. J. Environ. Res. Public Health 14:1540. doi: 10.3390/ijerph14121540, PMID: PubMed DOI PMC

Huang Y., Procházková M., Lu J., Riad A., Macek P. (2022). Family related variables’ influences on adolescents’ health based on health behaviour in school-aged children database, an AI-assisted scoping review, and narrative synthesis. Front. Psychol. 13:871795. doi: 10.3389/fpsyg.2022.871795, PMID: PubMed DOI PMC

Hurd N. M., Stoddard S. A., Zimmerman M. A. (2013). Neighborhoods, social support, and African American adolescents’ mental health outcomes: a multilevel path analysis. Child Dev. 84, 858–874. doi: 10.1111/cdev.12018, PMID: PubMed DOI PMC

Inchley J., Currie D., Budisavljevic S., Torsheim T., Jåstad A., Cosma A., et al. . (2020). Spotlight on adolescent health and well-being. Findings from the 2017/2018 health behaviour in school-aged children (HBSC) survey in Europe and Canada. International Report, 1.

Joyce H. D., Early T. J. (2014). The impact of school connectedness and teacher support on depressive symptoms in adolescents: a multilevel analysis. Child Youth Serv. Rev. 39, 101–107. doi: 10.1016/j.childyouth.2014.02.005, PMID: PubMed DOI PMC

Kelly C., Molcho M., Doyle P., Nic Gabhainn S. (2010). Psychosomatic symptoms among schoolchildren. Int. J. Adolesc. Med. Health 22, 229–235. doi: 10.1515/IJAMH.2010.22.2.229, PMID: PubMed DOI

Kinnunen P., Laukkanen E., Kylmä J. (2010). Associations between psychosomatic symptoms in adolescence and mental health symptoms in early adulthood. Int. J. Nurs. Pract. 16, 43–50. doi: 10.1111/j.1440-172X.2009.01782.x, PMID: PubMed DOI

Konowalczyk S., McKay M. T., Wells K. E., Cole J. C. (2018). The influence of time attitudes profile membership on mental well-being and psychosomatic symptomatology: a United Kingdom-based prospective study. Psychiatry Res. 261, 375–382. doi: 10.1016/j.psychres.2017.12.071, PMID: PubMed DOI

Kotchick B. A., Shaffer A., Miller K. S., Forehand R. (2001). Adolescent sexual risk behavior: a multi-system perspective. Clin. Psychol. Rev. 21, 493–519. doi: 10.1016/S0272-7358(99)00070-7, PMID: PubMed DOI

Lánský O., Tomková S. (2018). Czech Republic inequalities in Czech Republic intersecting inequalities due to long-term Manifestations and impacts of income inequality, embedded structural and developmental issues and social exclusion of women and ethnic minorities.

Leroy Z. C., Wallin R., Lee S. (2017). The role of school health services in addressing the needs of students with chronic health conditions: a systematic review. J. Sch. Nurs. 33, 64–72. doi: 10.1177/1059840516678909, PMID: PubMed DOI PMC

Lorig K. R., Holman H. R. (2003). Self-management education: history, definition, outcomes, and mechanisms. Ann. Behav. Med. 26, 1–7. doi: 10.1207/S15324796ABM2601_01, PMID: PubMed DOI

McConnell E. A., Birkett M. A., Mustanski B. (2015). Typologies of social support and associations with mental health outcomes among LGBT youth. LGBT Health 2, 55–61. doi: 10.1089/lgbt.2014.0051, PMID: PubMed DOI PMC

McConnell E. A., Birkett M., Mustanski B. (2016). Families matter: social support and mental health trajectories among lesbian, gay, bisexual, and transgender youth. J. Adolesc. Health 59, 674–680. doi: 10.1016/j.jadohealth.2016.07.026, PMID: PubMed DOI PMC

McDonough M. H., Jose P. E., Stuart J. (2016). Bi-directional effects of peer relationships and adolescent substance use: a longitudinal study. J. Youth Adolesc. 45, 1652–1663. doi: 10.1007/s10964-015-0355-4, PMID: PubMed DOI

McIntosh J. M., Lyon A. R., Carlson G. A., Everette C. D. B., Loera S. (2008). Measuring the mesosystem: a survey and critique of approaches to cross setting measurement for ecological research and models of collaborative care. Fam. Syst. Health 26, 86–104. doi: 10.1037/1091-7527.26.1.86 DOI

Mmari K., Lantos H., Blum R. W., Brahmbhatt H., Sangowawa A., Yu C., et al. . (2014). A global study on the influence of neighborhood contextual factors on adolescent health. J. Adolesc. Health 55, S13–S20. doi: 10.1016/j.jadohealth.2014.08.023, PMID: PubMed DOI PMC

Petanidou D., Giannakopoulos G., Tzavara C., Dimitrakaki C., Ravens-Sieberer U., Kolaitis G., et al. . (2012). Identifying the sociodemographic determinants of subjective health complaints in a cross-sectional study of Greek adolescents. Ann. General Psychiatry 11, 1–12. doi: 10.1186/1744-859X-11-17, PMID: PubMed DOI PMC

Piko B. F., Varga S., Mellor D. (2016). Are adolescents with high self-esteem protected from psychosomatic symptomatology? Eur. J. Pediatr. 175, 785–792. doi: 10.1007/s00431-016-2709-7, PMID: PubMed DOI

Potrebny T., Wiium N., Haugstvedt A., Sollesnes R., Torsheim T., Wold B., et al. . (2019). Health complaints among adolescents in Norway: a twenty-year perspective on trends. PLoS One 14:e0210509. doi: 10.1371/journal.pone.0210509, PMID: PubMed DOI PMC

Potrebny T., Wiium N., Lundegård M. M.-I. (2017). Temporal trends in adolescents’ self-reported psychosomatic health complaints from 1980-2016: a systematic review and meta-analysis. PLoS One 12:e0188374. doi: 10.1371/journal.pone.0188374, PMID: PubMed DOI PMC

Reissmannová J. S. (2021). Education in the area of human protection in emergency and crisis situations in the context of health education in the Czech Republic. CEPS J. 11, 109–134. doi: 10.26529/cepsj.1176 DOI

Rief W., Broadbent E. (2007). Explaining medically unexplained symptoms-models and mechanisms. Clin. Psychol. Rev. 27, 821–841. doi: 10.1016/j.cpr.2007.07.005, PMID: PubMed DOI

Rook K. S. (1984). The negative side of social interaction: impact on psychological well-being. J. Pers. Soc. Psychol. 46, 1097–1108. doi: 10.1037/0022-3514.46.5.1097, PMID: PubMed DOI

Schulte-Körne G. (2016). Mental health problems in a school setting in children and adolescents. Deutsches Arzteblatt Int. 113, 183–190. doi: 10.3238/arztebl.2016.0183, PMID: PubMed DOI PMC

Sellström E., Bremberg S. (2006). The significance of neighbourhood context to child and adolescent health and well-being: a systematic review of multilevel studies. Scand. J. Public Health 34, 544–554. doi: 10.1080/14034940600551251, PMID: PubMed DOI

Skaličková J., Mazalová V., Široký J. (2014). Identification of the differences between the regions of the Czech Republic based on the economic characteristics. Proc. Econ. Fin. 12, 343–352. doi: 10.1016/S2212-5671(14)00354-2 DOI

Stormshak E. A., Connell A. M., Véronneau M. H., Myers M. W., Dishion T. J., Kavanagh K., et al. . (2011). An ecological approach to promoting early adolescent mental health and social adaptation: family-centered intervention in public middle schools. Child Dev. 82, 209–225. doi: 10.1111/j.1467-8624.2010.01551.x, PMID: PubMed DOI PMC

Sumter S. R., Baumgartner S. E. (2017). Psychosomatic complaints in adolescence: untangling the relationship between offline and online peer victimization, psychosomatic complaints and social support. Eur. J. Dev. Psychol. 14, 399–415. doi: 10.1080/17405629.2016.1215980 DOI

Thompson I., Willemse M., Mutton T., Burn K., De Bruïne E. (2018). Teacher education and family–school partnerships in different contexts: a cross country analysis of national teacher education frameworks across a range of European countries. J. Educ. Teach. 44, 258–277. doi: 10.1080/02607476.2018.1465621 DOI

Univerzita Palackého v Olomouci (2018). Metodika HBSC – sběr dat 2018.

Villalonga-Olives E., Forero C. G., Erhart M., Palacio-Vieira J. A., Valderas J. M., Herdman M., et al. . (2011). Relationship between life events and psychosomatic complaints during adolescence/youth: a structural equation model approach. J. Adolesc. Health 49, 199–205. doi: 10.1016/j.jadohealth.2010.11.260, PMID: PubMed DOI

Williams J. H., Horvath V. E., Wei H.-S., Van Dorn R. A., Jonson-Reid M. (2007). Teachers’ perspectives of children’s mental health service needs in urban elementary schools. Child. Sch. 29, 95–107. doi: 10.1093/cs/29.2.95 DOI

Williams P. L., Storm D., Montepiedra G., Nichols S., Kammerer B., Sirois P. A., et al. . (2006). Predictors of adherence to antiretroviral medications in children and adolescents with HIV infection. Pediatrics 118, e1745–e1757. doi: 10.1542/peds.2006-0493 PubMed DOI

Wold B., Mittelmark M. B. (2018). Health-promotion research over three decades: the social-ecological model and challenges in implementation of interventions. Scand. J. Public Health 46, 20–26. doi: 10.1177/1403494817743893, PMID: PubMed DOI

Wong N. M. L., Yeung P. P. S., Lee T. M. C. (2018). A developmental social neuroscience model for understanding loneliness in adolescence. Soc. Neurosci. 13, 94–103. doi: 10.1080/17470919.2016.1256832, PMID: PubMed DOI

Xu T., Tomokawa S., Gregorio E. R., Jr., Mannava P., Nagai M., Sobel H. (2020). School-based interventions to promote adolescent health: a systematic review in low-and middle-income countries of WHO Western Pacific Region. PLoS One 15:e0230046. doi: 10.1371/journal.pone.0230046, PMID: PubMed DOI PMC

Yu S., Clemens R., Yang H., Li X., Stanton B., Deveaux L., et al. . (2006). Youth and parental perceptions of parental monitoring and parent-adolescent communication, youth depression, and youth risk behaviors. Soc. Behav. Personal. Int. J. 34, 1297–1310. doi: 10.2224/sbp.2006.34.10.1297 DOI