Cross-country comparisons of trends in adolescent psychosomatic symptoms - a Rasch analysis of HBSC data from four Nordic countries

Abstract

Background: To analyse the psychometric properties of the HBSC Symptom Checklist (HBSC-SCL) on psychosomatic symptoms with a focus on the operating characteristics of the items, and on the impacts of measurement distortions on the comparisons of person measures across time and between countries.

Methods: Data were collected in 1993/94, 1997/98, 2001/02, 2005/06, 2008/09, 2013/14 in Denmark, Finland, Norway and Sweden as part of the Health Behaviour in School-aged Children (HBSC) study. Data comprised 116,531 students 11, 13 and 15 years old. Rasch analysis was conducted of the HBSC-SCL consisting of eight items with a focus on Differential Item Functioning (DIF) and item threshold ordering. The impacts of DIF and threshold disordering on trend analyses were analysed in a subsample consisting of 15 years old students.

Results: One item shows evidence of severe DIF and the categorisation of some items does not seem to work as intended. Analyses of changes based on proportions of psychosomatic symptoms show that bad item functioning affects some comparisons between countries across time: A four percentage point difference between 15 years old girls in Finland and Sweden concerning the rate of increase of psychosomatic symptoms from 1994 to 2014 disappears when the problems with DIF and disordered item thresholds are taken into account. Although the proportions of students with psychosomatic symptoms are clearly higher 2014 than 1994 in all four countries the shape of most trends is nonlinear.

Conclusions: Some of the cross-country comparisons were distorted because of DIF and problems related to disordering of the item thresholds. The comparisons among girls between Finland and Sweden were affected by the problems pertaining to the original measure of psychosomatic symptoms, while the trend patterns among boys were not much affected. In addition to confirming increasing rates of adolescent mental health problems in the Nordic countries, the substantive analyses in the current study show that Finland is joining Sweden in having the sharpest increase among older adolescents, in particular among girls. To improve the functioning of the scale the DIF item could be removed or replaced and response categories collapsed in post hoc analyses.

Keywords: Adolescents; Differential item functioning; HBSC; Psychosomatic symptoms; Rasch measurement theory; Trend analyses.

Fig. 1

Person-item threshold distribution for the set of eight items, with five response categories. Entire sample of students 11, 13 and 15 years old. The higher the value, the less psychosomatic symptoms

Fig. 2

a Category probability curve for item “Have been irritable or in a bad temper” for set of eight items with five response categories. b Category probability curve for item “Backache” for set of eight items with five response categories. Entire sample of students 11, 13 and 15 years old

Fig. 3

a-b Differential item functioning across countries for item Feeling Low, before (a) and after (b) resolving DIF. Set of eight items with three response categories. Entire sample of students 11, 13 and 15 years old

Fig. 4

a-d Differential Item Functioning across years of investigation for the item Feeling Low in four Nordic countries. Set of eight items with three response categories. Entire sample of students 11, 13 and 15 years old

Fig. 5

a-b Mean values of psychosomatic symptoms on a transformed 0–100 score scale among 15 years old boys, distributed by countries. a Original eight items with five response categories; b Seven items set with three response categories. The higher the value, the higher degree of psychosomatic symptoms

Fig. 6

a-b Mean values of psychosomatic symptoms on a transformed 0–100 score scale among 15 years old girls, distributed by countries. a Original eight items with five response categories; b Seven items with three response categories. The higher the value, the higher degree of psychosomatic symptoms

Fig. 7

a-b Psychosomatic symptoms among 15 years old boys, distributed by countries. a Original eight items with five response categories; b Seven items set with three response categories. Proportion of students on a transformed 0–100 score scale at or above the 90th percentile (worse health) for the entire sample in 1994

Fig. 8

a-b Psychosomatic symptoms among 15 years old girls, distributed by countries. a Original eight items with five response categories; b Seven items with three response categories. Proportion of students on a transformed 0–100 score scale at or above the 90th percentile (worse health) for the entire sample in 1994