OBJECTIVES: This study examined (non-)monotonic time trends in psychological and somatic complaints among adolescents, along with gender differences. METHODS: Repeated cross-sectional Health Behaviour in School-aged Children (HBSC) data from 1994 to 2022 covering 15-year-old adolescents from 41 countries (N = 470,797) were analysed. Three polynomial logistic regression models (linear, quadratic, cubic) were tested for best fit, including separate analyses by gender and health complaints dimension. RESULTS: Time trend patterns varied by gender and health complaints dimension. Increases were found in 82.3% of cases (linear 25%, quadratic U-shaped 28.7%, cubic 28.7%), while 14% showed no clear trend, and 3.7% decreased. Boys typically showed linear increases or no clear trend over time, whereas girls generally showed cubic or U-shaped trends. Psychological complaints often displayed U-shaped or cubic patterns, whereas somatic complaints mostly showed linear increases. CONCLUSION: Psychological and somatic complaints demonstrated diverse time trend patterns across countries, with non-monotonic patterns (U-shaped and cubic) frequently observed alongside linear increases. These findings highlight the complexity of changes within countries over three decades, suggesting that linear modelling may not effectively capture this heterogeneity.

Arabkir Medical Centre Institute of Child and Adolescent Health Yerevan Armenia

Centre for Health Services Studies University of Kent Canterbury United Kingdom

Department of Child and Adolescent Psychiatry Psychotherapy and Psychosomatics University Medical Center Hamburg Eppendorf Hamburg Germany

Department of Health and Functioning Western Norway University of Applied Sciences Bergen Norway

Department of Public Health and Pediatrics University of Torino Torino Italy

Department of Public Health and Primary Care Ghent University Ghent Belgium

Department of Social Sciences University of Luxembourg Esch sur Alzette Luxembourg

Institute of Social Medicine and Medical Ethics Faculty of Medicine Comenius University in Bratislava Bratislava Slovakia

National Institute of Public Health Ljubljana Slovenia

Olomouc University Social Health Institute Palacky University Olomouc Olomouc Czechia

School of Psychology and Life Sciences SPIC Hei Lab Lusófona University Lisbon Portugal

School of Psychology Trinity College Dublin Dublin Ireland

School of Psychology University of New England Armidale NSW Australia

See more in PubMed

Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al. Our Future: A Lancet Commission on Adolescent Health and Wellbeing. Lancet (2016) 387(10036):2423–78. 10.1016/s0140-6736(16)00579-1 PubMed DOI PMC

Cosma A, Abdrakhmanova S, Taut D, Schrijvers K, Catunda C, Schnohr C. A Focus on Adolescent Mental Health and Well-Being in Europe, Central Asia and Canada. In: Health Behaviour in School-Aged Children International Report from the 2021/2022 Survey. Copenhagen: WHO Regional Office for Europe; (2023).

Inchley J, Currie D, Budisavljevic S, Torsheim T, Jåstad A, Cosma A. Spotlight on Adolescent Health and Well-Being. Findings from the 2017/2018 Health Behaviour in School-Aged Children (HBSC) Survey in Europe and Canada. In: International Report. Copenhagen: WHO Regional Office for Europe; (2020).

Ravens-Sieberer U, Torsheim T, Hetland J, Vollebergh W, Cavallo F, Jericek H, et al. Subjective Health, Symptom Load and Quality of Life of Children and Adolescents in Europe. Int J Public Health (2009) 54(2):151–9. 10.1007/s00038-009-5406-8 PubMed DOI

Beck JE. A Developmental Perspective on Functional Somatic Symptoms. J Pediatr Psychol (2008) 33(5):547–62. 10.1093/jpepsy/jsm113 PubMed DOI

Grigorian K, Östberg V, Raninen J, Åhlén J, Brolin Låftman S. Prospective Associations between Psychosomatic Complaints in Adolescence and Depression and Anxiety Symptoms in Young Adulthood: A Swedish National Cohort Study. SSM Popul Health (2023) 24:101509. 10.1016/j.ssmph.2023.101509 PubMed DOI PMC

Wu Y, Wang L, Tao M, Cao H, Yuan H, Ye M, et al. Changing Trends in the Global Burden of Mental Disorders From 1990 to 2019 and Predicted Levels in 25 Years. Epidemiol Psychiatr Sci (2023) 32(e63):e63–9. 10.1017/s2045796023000756 PubMed DOI PMC

Cosma A, Stevens G, Martin G, Duinhof EL, Walsh SD, Garcia-Moya I, et al. Cross-National Time Trends in Adolescent Mental Well-Being From 2002 to 2018 and the Explanatory Role of Schoolwork Pressure. J Adolesc Health (2020) 66(6s):S50-S58–s8. 10.1016/j.jadohealth.2020.02.010 PubMed DOI PMC

Inchley J, Currie D, Piper A, Jåstad A, Cosma A, Nic Gabhainn S, et al. Health Behaviour in School-Aged Children (HBSC) Study Protocol: Background, Methodology, Mandatory Questions and Optional Packages for the 2021/22 Survey. In: MRC/CSO Social and Public Health Sciences Unit. Glasgow: University of Glasgow; (2023).

Potrebny T, Wiium N, Lundegård MM-I. Temporal Trends in Adolescents’ Self-Reported Psychosomatic Health Complaints from 1980-2016: A Systematic Review and Meta-Analysis. PLoS One (2017) 12(11):e0188374. 10.1371/journal.pone.0188374 PubMed DOI PMC

Hetland J, Torsheim T, Aarø LE. Subjective Health Complaints in Adolescence: Dimensional Structure and Variation across Gender and Age. Scand J Public Health (2002) 30(3):223–30. 10.1080/140349402320290953 PubMed DOI

Haugland S, Wold B, Stevenson J, Aaroe LE, Woynarowska B. Subjective Health Complaints in Adolescence. A Cross-National Comparison of Prevalence and Dimensionality. Eur J Public Health (2001) 11(1):4–10. 10.1093/eurpub/11.1.4 PubMed DOI

Heinz A, Sischka PE, Catunda C, Cosma A, García-Moya I, Lyyra N, et al. Item Response Theory and Differential Test Functioning Analysis of the HBSC-Symptom-Checklist Across 46 Countries. BMC Med Res Methodol (2022) 22(1):253. 10.1186/s12874-022-01698-3 PubMed DOI PMC

Ravens-Sieberer U, Erhart M, Torsheim T, Hetland J, Freeman J, Danielson M, et al. An International Scoring System for Self-Reported Health Complaints in Adolescents. Eur J Public Health (2008) 18(3):294–9. 10.1093/eurpub/ckn001 PubMed DOI

Dey M, Jorm AF, Mackinnon AJ. Cross-sectional Time Trends in Psychological and Somatic Health Complaints Among Adolescents: A Structural Equation Modelling Analysis of 'Health Behaviour in School-Aged Children' Data From Switzerland. Soc Psychiatry Psychiatr Epidemiol (2015) 50(8):1189–98. 10.1007/s00127-015-1040-3 PubMed DOI

Potrebny T, Wiium N, Haugstvedt A, Sollesnes R, Torsheim T, Wold B, et al. Health Complaints Among Adolescents in Norway: A Twenty-Year Perspective on Trends. PLoS One (2019) 14(1):e0210509. 10.1371/journal.pone.0210509 PubMed DOI PMC

Boer M, Van Dorsselaer S, De Looze M, De Roos S, Brons H, Van den Eijnden R, et al. Gezondheid en welzijn van jongeren in Nederland. Utrecht: Universiteit Utrecht; (2022).

Inchley J, Mabelis J, Brown J, Willis M, Currie D. Health Behaviour in School-Aged Children (HBSC) 2022 Survey in Scotland: National Report. Glasgow: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow; (2023).

Hulbert S, Eida T, Ferris E, Hrytsenko V, Kendall S. HBSC England National Report: Findings from the 2021-2022 HBSC Study for England. Kent: University of Kent; (2023).

Bersia M, Berchialla P, Charrier L, Lemma P, Borraccino A, Nardone P, et al. Mental Well-Being: 2010-2018 Trends Among Italian Adolescents. Int J Environ Res Public Health (2022) 19(2):863. 10.3390/ijerph19020863 PubMed DOI PMC

Cosma A, Költo A, Badura P, Winkler P, Kalman M. Time Trends in Adolescent Mental Wellbeing in the Czech Republic Between 2002 and 2018: Gender, Age and Socioeconomic Differences. Cent Eur J Public Health (2021) 29(4):271–8. 10.21101/cejph.a6717 PubMed DOI

Hammami N, Da Silva MA, Elgar FJ. Trends in Gender and Socioeconomic Inequalities in Adolescent Health Over 16 Years (2002-2018): Findings From the Canadian Health Behaviour in School-Aged Children Study. Health Promotion Chronic Dis Prev Can (2022) 42(2):68–78. 10.24095/hpcdp.42.2.03 PubMed DOI PMC

Mazur J, Klanšček HJ, Augustine L, Porwit K, Sigmund E, Šmigelskas K. Trends in Multiple Health Complaints in Polish Adolescents in Light of Data From 30 European Countries and Canada (2002-2018). J Mother Child (2021) 25(1):25–34. 10.34763/jmotherandchild.20212501.d-21-00011 PubMed DOI PMC

Boer M, Cosma A, Twenge J, Inchley J, Klanšček H, Stevens G. National-Level Schoolwork Pressure, Family Structure, Internet Use, and Obesity as Drivers of Time Trends in Adolescent Psychological Complaints Between 2002 and 2018. J Youth Adolesc (2023) 52:2061–77. 10.1007/s10964-023-01800-y PubMed DOI PMC

Ottová-Jordan V, Smith ORF, Gobina I, Mazur J, Augustine L, Cavallo F, et al. Trends in Multiple Recurrent Health Complaints in 15-Year-Olds in 35 Countries in Europe, North America and Israel From 1994 to 2010. Eur J Public Health (2015) 25(Suppl. l_2):24–7. 10.1093/eurpub/ckv015 PubMed DOI

Hammami N, Da Silva MA, Elgar FJ. Evolution of Health Inequalities Among Adolescents Based on Gender and Socioeconomic Status Over 16 Years (2002 to 2018): Results of the Study on Health Behaviors of School-Aged Children. Health Promotion Chronic Dis Prev Can (2022) 42(2):77–88. 10.24095/hpcdp.42.2.03f PubMed DOI PMC

Buli BG, Lehtinen-Jacks S, Larm P, Nilsson KW, Hellström-Olsson C, Giannotta F. Trends in Psychosomatic Symptoms Among Adolescents and the Role of Lifestyle Factors. BMC Public Health (2024) 24(1):878. 10.1186/s12889-024-18327-x PubMed DOI PMC

Friedman J, Hastie T, Tibshirani R. Regularization Paths for Generalized Linear Models via Coordinate Descent. J Stat Softw (2010) 33:1–22. 10.18637/jss.v033.i01 PubMed DOI PMC

Ioannidis JPA. What Have We (Not) Learnt from Millions of Scientific Papers With P-Values? Am Statistician (2019) 73:20–5. 10.1080/00031305.2018.1447512 DOI

Cosma A, Bersia M, Abdrakhmanova S, Badura P, Gobina I. Coping through Crisis: COVID-19 Pandemic Experiences and Adolescent Mental Health and Well-Being in the WHO European Region: Impact of the COVID-19 Pandemic on Young People’s Health and Well-Being from the Findings of the HBSC Survey Round 2021/2022. In: Regional Office for Europe. Copenhagen: World Health Organization; (2023).

Whitehead RD, Cosma A, Cecil J, Currie C, Currie D, Neville F, et al. Trends in the Perceived Body Size of Adolescent Males and Females in Scotland, 1990–2014: Changing Associations with Mental Well-Being. Int J Public Health (2018) 63(1):69–80. 10.1007/s00038-017-0997-y PubMed DOI PMC

Keyes KM, Platt JM. Annual Research Review: Sex, Gender, and Internalizing Conditions Among Adolescents in the 21st Century - Trends, Causes, Consequences. J Child Psychol Psychiatry (2023) 65(4):384–407. 10.1111/jcpp.13864 PubMed DOI

Bor W, Dean AJ, Najman J, Hayatbakhsh R. Are Child and Adolescent Mental Health Problems Increasing in the 21st Century? A Systematic Review. Aust N Z J Psychiatry (2014) 48(7):606–16. 10.1177/0004867414533834 PubMed DOI

Mana A, Super S, Sardu C, Juvinya Canal D, Moran N, Sagy S. Individual, Social and National Coping Resources and Their Relationships with Mental Health and Anxiety: A Comparative Study in Israel, Italy, Spain, and the Netherlands during the Coronavirus Pandemic. Glob Health Promotion (2021) 28(2):17–26. 10.1177/1757975921992957 PubMed DOI PMC

Wagner G, Glick P, Khammash U, Shaheen M, Brown R, Goutam P, et al. Exposure to Violence and its Relationship to Mental Health Among Young People in Palestine. East Mediterr Health J (2020) 26(2):189–97. 10.26719/2020.26.2.189 PubMed DOI

Diamantis DV, Stavropoulou I, Katsas K, Mugford L, Linos A, Kouvari M. Assessing Quality of Life in First- and Second-Generation Immigrant Children and Adolescents; Highlights From the DIATROFI Food Aid and Healthy Nutrition Promotion Program. Int J Environ Res Public Health (2023) 20(3):2471. 10.3390/ijerph20032471 PubMed DOI PMC

Karagianni P. Youth Mental Health Context in Greece. The Eur Health Psychol (2016) 18(3):119–22.

Barbieri V, Wiedermann CJ, Kaman A, Erhart M, Piccoliori G, Plagg B, et al. Quality of Life and Mental Health in Children and Adolescents after the First Year of the COVID-19 Pandemic: A Large Population-Based Survey in South Tyrol, Italy. Int J Environ Res Public Health (2022) 19(9):5220. 10.3390/ijerph19095220 PubMed DOI PMC

Bersia M, Charrier L, Berchialla P, Cosma A, Comoretto RI, Dalmasso P. The Mental Well-Being of Italian Adolescents in the Last Decade through the Lens of the Dual Factor Model. Children-Basel (2022) 9(12):1981. 10.3390/children9121981 PubMed DOI PMC

Hiilamo A, Hiilamo H, Ristikari T, Virtanen P. Impact of the Great Recession on Mental Health, Substance Use and Violence in Families with Children: A Systematic Review of the Evidence. Child Youth Serv Rev (2021) 121:105772. 10.1016/j.childyouth.2020.105772 DOI

van Nieuwenhuizen A, Hudson K, Chen X, Hwong AR. The Effects of Climate Change on Child and Adolescent Mental Health: Clinical Considerations. Curr Psychiatry Rep (2021) 23(12):88. 10.1007/s11920-021-01296-y PubMed DOI

Martin G, Reilly K, Everitt H, Gilliland JA. Review: The Impact of Climate Change Awareness on Children's Mental Well-Being and Negative Emotions - A Scoping Review. Child Adolesc Ment Health (2022) 27(1):59–72. 10.1111/camh.12525 PubMed DOI

Bendavid E, Boerma T, Akseer N, Langer A, Malembaka EB, Okiro EA, et al. The Effects of Armed Conflict on the Health of Women and Children. Lancet (2021) 397(10273):522–32. 10.1016/s0140-6736(21)00131-8 PubMed DOI PMC

Sohn SY, Rees P, Wildridge B, Kalk NJ, Carter B. Prevalence of Problematic Smartphone Usage and Associated Mental Health Outcomes Amongst Children and Young People: A Systematic Review, Meta-Analysis and Grade of the Evidence. BMC Psychiatry (2019) 19(1):356. 10.1186/s12888-019-2350-x PubMed DOI PMC

Ferguson CJ, Kaye LK, Branley-Bell D, Markey P, Ivory JD, Klisanin D, et al. Like This Meta-Analysis: Screen Media and Mental Health. Prof Psychol Res Pract (2022) 53(2):205–14. 10.1037/pro0000426 DOI

Radtke T, Apel T, Schenkel K, Keller J, von Lindern E. Digital Detox: An Effective Solution in the Smartphone Era? A Systematic Literature Review. Mobile Media and Commun (2022) 10(2):190–215. 10.1177/20501579211028647 DOI

König D, Fellinger M, Pruckner N, Hinterbuchinger B, Dorffner G, Gleiss A, et al. Availability and Use of Mental Health Services in European Countries: Influence on National Suicide Rates. J Affect Disord (2018) 239:66–71. 10.1016/j.jad.2018.06.042 PubMed DOI

Michaud P-A, Visser A, Vervoort JPM, Kocken P, Reijneveld SA, Jansen DEMC. Availability and Accessibility of Primary Mental Health Services for Adolescents: An Overview of National Recommendations and Services in EU. Eur J Public Health (2020) 30(6):1127–33. 10.1093/eurpub/ckaa102 PubMed DOI

McGorry PD, Mei C, Chanen A, Hodges C, Alvarez-Jimenez M, Killackey E. Designing and Scaling up Integrated Youth Mental Health Care. World Psychiatry (2022) 21(1):61–76. 10.1002/wps.20938 PubMed DOI PMC

Foulkes L, Andrews JL. Are Mental Health Awareness Efforts Contributing to the Rise in Reported Mental Health Problems? A Call to Test the Prevalence Inflation Hypothesis. New Ideas Psychol (2023) 69:101010. 10.1016/j.newideapsych.2023.101010 DOI

Kuosmanen T, Clarke AM, Barry MM. Promoting Adolescents' Mental Health and Wellbeing: Evidence Synthesis. J Public Ment Health (2019) 18(1):73–83. 10.1108/jpmh-07-2018-0036 DOI