title: Social support and family communication as factors protecting adolescents against multiple recurrent health complaints related to school stress.
abstract: BACKGROUND
  One reason of increased psychological and somatic health problems in adolescence is intensification of stress in school and everyday life. There is little evidence to what extent the level of school achievements shapes this relationship.
  
  
  OBJECTIVE
  The aim of the study was to investigate determinants of subjective health complaints in schoolaged children, taking into account the interaction effects.
  
  
  METHODS
  Anonymous survey was conducted in Poland in 2013/2014 on the sample of 4,545 students, as a part of the HBSC (Health Behaviour in School-aged Children) study. On the basis of prevalence of eight symptoms in the past 6 months, a standardized index of health complaints (SCL - Subjective Complaints Checklist) was calculated (0-100). To predict its variability three hierarchical linear models (five blocks) were estimated, separately for three levels of school achievements. Support from family, classmates and teachers as well as family communication were considered as protective factors, which can reduce the negative impact of stress. All analyses were adjusted for age, gender and family affluence.
  
  
  RESULTS
  The standardized SCL index was equal to 23.2 in boys and 32.5 in girls. The high level of school stress was reported by 28.5% boys and 35.6% girls, respectively. Regarding these two measures, similar patterns of change were observed, increase with age and with deterioration of academic achievement. Final multivariate models explained 22-25% variability of SCL, slightly more among worst students. Accumulation of low family support and high level of school stress caused the highest increase in the SCL index in very good students.
  
  
  CONCLUSIONS
  School performance is an important determinant of subjective health complaints in adolescence, also modifying the impact of other risk and protective factors.
authors.affiliation: Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland, e-mail: izabela.tabak@imid.med.pl.
authors.forename: Izabela
authors.initials: I
authors.lastname: Tabak
authors.affiliation: Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Mazur
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D003142:Communication; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D010698:Phobic Disorders / Q000453:epidemiology / Q000209:etiology*; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D000297:Psychology, Adolescent; D012574:Schools; D012737:Sex Factors; D012944:Social Support; D013315:Stress, Psychological / Q000150:complications*; D013334:Students / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: adolescents; family communication; school achievements; school stress; social support; subjective health complaints