title: Risk and protective factors for psychological distress among adolescents: a family study in the Nord-Trøndelag Health Study.
abstract: OBJECTIVE
  The study aimed to investigate potential adolescent and parental psychosocial risk and protective factors for psychological distress among adolescents and, in addition, to examine potential gender and age differences in the effects of risk factors on adolescent psychological distress.
  
  
  METHODS
  Data were collected among 8,984 Norwegian adolescents (13-19 years) and their parents in the Nord-Trøndelag Health Study (HUNT). The outcome measure was psychological distress (SCL-5).
  
  
  RESULTS
  Bivariate regression analysis with generalized estimating equation (GEE) model showed that all parental self-reported variables (mental distress, substance use, social network, economic problems, unemployment and family structure) and adolescents' self-reported variables (leisure activities, social support from friends, school-related problems and substance use) were significantly associated with psychological distress among adolescents. Results revealed that in a multiple regression analysis with a GEE model, adolescent psychosocial variables, specifically academic-related problems and being bullied at school, emerged as the strongest predictors of psychological distress among adolescents after controlling for age, gender, and all parental and adolescent variables. The following psychosocial risk factors were significantly more important for girl's psychological distress compared to boys: problems with academic achievement, conduct problems in school, frequency of being drunk, smoking, dissatisfaction in school, living alone and seen parents being drunk.
  
  
  CONCLUSIONS
  Academic achievement and being bullied at school were the psychosocial factors most strongly associated with psychological distress among adolescents. Parental factors had an indirect effect on adolescent psychological distress, through adolescents' psychosocial factors.
authors.affiliation: Division of Mental Health, Department of Children and Adolescents, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, 0403, Oslo, Norway. ingri.myklestad@fhi.no
authors.forename: Ingri
authors.initials: I
authors.lastname: Myklestad
authors.forename: Espen
authors.initials: E
authors.lastname: Røysamb
authors.forename: Kristian
authors.initials: K
authors.lastname: Tambs
mesh_terms: D000124:Achievement; D000293:Adolescent; D000328:Adult; D058445:Bullying / Q000523:psychology*; D005192:Family Health; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008297:Male; D009664:Norway / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology; D012044:Regression Analysis; D012307:Risk Factors; D012574:Schools / Q000706:statistics & numerical data; D057566:Self Report; D017678:Sex Distribution; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology*; D013334:Students / Q000523:psychology*; D019966:Substance-Related Disorders; D055815:Young Adult