Explanations for female excess psychosomatic symptoms in adolescence: evidence from a school-based cohort in the West of Scotland

Background: By mid adolescence there is an excess in female physical and/or psychosomatic, as well as psychological morbidity. This paper examines the contribution of a range of factors (self-esteem, body image, gender-role orientation, body mass index, smoking and physical activity) to explaining the female excess in three psychosomatic symptoms (headaches, stomach ache/sickness, and dizziness) and depressive mood at age 15. Methods: A cohort of 2,196 school pupils (analyses restricted to 2,005 with complete data) surveyed at age 15. All measures were obtained via self-completion questionnaires, apart from body mass index, derived from measured height and weight. Analyses examined (a) sex differences in each potential explanatory factor; (b) their associations with the health measures; (c) the effect of adjustment for these factors on sex differences in the health measures; and (d) the existence of interactive effects between sex and the explanatory factors on the health measures Results: Each potential explanatory factor was significantly differentiated by sex. Self-esteem, body image (represented by weight-related worries), smoking and physical activity were related to the health measures. These factors accounted for one third of the female excess in headaches and stomach problems, half the excess in dizziness and almost all that in respect of depressive mood. Self-esteem and body image were the factors most consistently related to health, and adjustment for these resulted in the largest reductions in the odds of a female excess in both the psychosomatic symptoms and depressive mood. Conclusion: Adjustment for a range of potential psychosocial and behavioural factors largely explains (statistically) excess female depressive mood. These factors also partially explain the female excess in certain psychosomatic symptoms.