Intergenerational estrangement is a new but growing field of research. Studies have suggested that estrangement is associated with negative emotional outcomes, especially for older parents. This study explored how older parents cope with being estranged from their children. In-depth interviews with 15 older parents (M = 83 years), seven fathers and eight mothers, were conducted to gain insights into coping responses. Participants were recruited via purposive sampling. Inspired by the intergenerational ambivalence perspective and the dual process model of coping with bereavement, the study identified two primary coping orientations: (a) reconciliation-oriented coping, aimed at reestablishing contact with children, and (b) acceptance-oriented coping, aimed at coming to terms with the estrangement. Avoidance was identified as a third coping orientation that did not fit the theoretical framework. Parents were found to oscillate between all three coping orientations.

Parent-child relationships are among the most important social connections throughout life. Estrangement from one or more children has been shown to evoke feelings of sorrow for parents as they move closer to the end of life. Yet family estrangement in older age has not garnered much attention in the scientific literature, and associations with mental health remain unresolved. The purpose of the present study was to examine the association between mental health and estrangement from adult children for older parents on dimensions of well-being, sense of purpose, depression, and loneliness. Survey data were collected from older parents (aged 75+) with estrangement to at least one child (n = 75) and a corresponding comparison group of older parents (n = 196). Data included measurements of well-being (WHO-5), sense of purpose (PIL-SF), depressive symptoms (CMDQ), and loneliness (UCLA-3). Statistical analyses using multiple linear regression were conducted for each measurement to test for associations with intergenerational estrangement. Intergenerational estrangement was found to be statistically significantly associated with poorer mental health scores on all four measurements. The study is the first to document multiple, specific, negative psychological and social associations with intergenerational estrangement for older parents. The study argues for the potential benefits of family work in efforts to promote mental health in older age.

Loneliness in adolescence is a serious threat to quality of life. The purpose of this study was to examine the association between loneliness and ease of communication with parents and friends, and whether the association was different for boys and girls. The study used data from the Danish arm of the international Health Behaviour in School-aged Children (HBSC). The surveys in 2010, 2014 and 2018 included nationally representative samples of students in the age groups, 11-, 13- and 15-year-olds (n = 10,425). Loneliness was measured by one item and ease of communication with parents and friends by the HBSC Ease of Communication Measure. Multilevel multivariate logistic regression was applied to study the associations between ease of communication and loneliness. Stratified analysis and interaction analysis tested the modifying effect of sex on the associations. The prevalence of loneliness wa 4.3

1) to study time trends in the prevalence of recurrent dizziness among adolescents in Denmark 1991–2022, and 2) to examine how dizziness was associated with sociodemographic factors, mental health related factors, health status, and health behaviours in 2022. The study focused on recurrent dizziness, i.e. episodes of dizziness several times a week during the last six months. Data stem from the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study which included 11-, 13- and 15-year-olds from random samples of schools in nine comparable surveys from 1991 to 2022, n = 40,102. We applied multivariate logistic regression analyses in the 2022 dataset (n = 5,737) to examine how dizziness was associated with other factors. In 2022, the prevalence of recurrent dizziness was 14.3

The objective was to examine trends in low school satisfaction between 1994 and 2022 among 11-15-year-old students in Denmark according to sex, grade, and socioeconomic status. We focused on trends before and after a major school reform in 2014, and before and after COVID-19-related school closures 2020-2021. Data stem from the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study (N = 38,858). Expressions of low school satisfaction declined from 21.2% in 1994 to 17.2% in 2022 (p < 0.0001). Low school satisfaction also declined during the pre-reform period, 1994-2014 (p < 0.0001), but increased slightly in the post-reform period, 2014-2022 (p = 0.0006). Low school satisfaction was more common among boys than girls. It increased by grade and was highest among students from low socioeconomic background. The COVID-19-related school closures may have impacted school satisfaction negatively and school reform may have been insufficient to improve school satisfaction after 2014.

IntroductionRegulatory problems of eating, sleeping, and crying in infancy may index mental health vulnerability in older ages, and knowledge is needed to inform strategies to break the developmental trajectories of dysregulation in early childhood. In this study, we examined the prospective associations between infant regulatory problems at the age of 8–10 months identified by community health nurses (CHN) and mental disorders diagnosed in hospital settings in children aged 1–8 years.MethodsFrom a cohort of all newborn children in 15 municipalities in the Capital Region of Copenhagen (N = 43,922) we included all children who were examined by CHNs at the scheduled home visit at the age of 8–10 months (N = 36,338). Outcome measures were ICD-10 mental disorders diagnosed at public hospitals and reported to the National Patient Register. Logistic regression included data on child and family covariables obtained from population registers.ResultsThe CHNs reported concerns regarding sleep in 7.7% of the study population, feeding and eating in 19.1%, combined sleeping and eating problems in 3.6%, and incessant crying in 0.7%. A total of 1,439 children (4% of the study population) were diagnosed in hospital settings with an ICD-10 mental disorder between the ages of 11 months and 8 years. Analyses adjusted for a range of perinatal and family adversities showed an increased risk of any neurodevelopmental disorder among children with CHN concerns of feeding and eating (odds ratio (OR) 1.36 (95% confidence interval (CI) 1.14–1.63)) and co-occurrent problems of feeding and eating and sleep (OR 1.60 (95% CI 1.14–2.26)). For autism-spectrum disorders, an increased risk was seen among children with co-occurrent problems of both feeding and eating and sleep (OR 1.73 (95% CI 1.07–2.79)). Concern about feeding and eating was also associated with an increased risk of behavioral and emotional disorders (OR 1.27 (95% CI 1.03–1.56)). Concern about incessant crying at the age of 8–10 months was not associated with a diagnosed mental disorder, but findings may reflect low statistical power due to low frequency of concern.DiscussionCHN concerns mirror a group of developmentally vulnerable children. Further research is needed to explore the possibilities of preventive intervention within the general child health surveillance to address the developmental psychopathology of dysregulation in early ages.

PURPOSE:This study examined the prevalence of headache medicine use among Danish adolescents and explores the link between mental health, frequent headaches, and medicine use for headache. We hypothesized that poor mental health increases headache occurrence, leading to greater medicine use. METHODS:The 2022 Danish Health Behaviour in School-aged Children (HBSC) study surveyed 5292 students aged 11, 13, and 15. Self-reported data included headache frequency, medicine use for headache, and five mental health indicators: life satisfaction, emotional symptoms, loneliness, self-efficacy, and self-esteem. Multivariate logistic regression analyses assessed the association between mental health indicators and headache medicine use, adjusting for headache frequency. RESULTS:Weekly headaches were reported by 33.1%, and 43.6% used headache medicine in the past month. Poor mental health correlated with higher headache and medicine use rates. Analyses adjusted for sex, age group, and occupational social class found significantly increased odds ratios (95% confidence interval) for medicine use for headache among students with low life satisfaction (2.27; 1.88-2.75), among students with 2+ emotional symptoms (2.28; 1.92-2.69), students who often felt lonely (2.08; 1.69-2.55), students with low self-efficacy (1.37; 1.16-1.61) and students with low self-esteem (1.59; 1.36-1.85). When accounting for headache frequency, the association between poor mental health and medicine use diminished and became nonsignificant. CONCLUSIONS:Poor mental health was linked to increased medicine use for headache. The findings suggest that frequent headaches may explain the association between poor mental health and the use of headache medicine. Promoting rational medicine use and enhancing mental health among adolescents is essential.

Objectives To examine trends in socioeconomic inequality in adolescent health over three decades, across fifteen health indicators: overweight, underweight, headache, stomachache, backpain, emotional symptoms, difficulties falling asleep, loneliness, low life satisfaction, low self-rated heath, smoking, drunkenness, physical inactivity, low vegetable intake, and inadequate toothbrushing.Methods The Health Behaviour in School-aged Children (HBSC) study in Denmark included nine identical surveys of 11-15-year-olds from 1991 to 2022, n = 35,423. For each health indicator, we measured absolute and relative socioeconomic inequality by prevalence differences and odds ratios between low and high socioeconomic groups.Results There was socioeconomic inequality in thirteen health indicators, e.g., the OR (95% CI) for overweight in low vs. high socioeconomic groups was 2.22 (1.95-2.49). This social inequality persisted across health indicators throughout the study period with two deviations: Underweight was not associated with socioeconomic background and drunkenness was persistently most prevalent in higher socioeconomic groups.Conclusion The political efforts to reduce socioeconomic inequality in health seems to have failed. It is important to improve monitoring of adolescent health and implement improved policies to tackle socioeconomic inequality in adolescent health.

Aims: The aim was to examine how loneliness was associated with bullying victimization at school and online. Methods: We used data from the Danish arm of the international Health Behavior in School-aged Children (HBSC) study from 2022. The study population was a nationally representative sample of 11–15-year-olds who completed the internationally standardized HBSC questionnaire at school, n = 5382. Multilevel logistic regression was applied to study the associations between bullying victimization and loneliness. Results: The prevalence of reporting loneliness often or very often was 9.0%; 6.3% of the sample experienced habitual bullying victimization at school, and 4.8% incurred cyberbullying. There was a strong and graded association between loneliness and bullying victimization at school and cyberbullying. The associations were significant for boys and girls, and the association between exposure to bullying at school and loneliness was steeper for boys than girls. The gradients were steeper for physical bullying than for cyberbullying. Students exposed to habitual bullying in both contexts had an adjusted OR (95% CI) of 11.21 (6.99–17.98) for loneliness. Conclusion: Exposure to bullying at school and cyberbullying are strongly associated with loneliness. It is important to reduce bullying at school and on the internet and to promote effective interventions to reduce continuing loneliness.

Objectives: Recurrent pain is a prevalent and severe public health problem among adolescents and is associated with several negative health outcomes. In a representative sample of adolescents this study examined 1) whether exposure to bullying and low socioeconomic status (SES) were associated with recurrent headache, stomachache and backpain, 2) the combined effect of exposure to bullying and low SES on recurrent pain and 3) whether SES modified the association between bullying and recurrent pain.Methods: Data derived from the Danish contribution to the international collaborative study Health Behaviour in School-aged Children (HBSC). The study population was students in three age groups, 11-, 13- and 15-year-olds from nationally representative samples of schools. We pooled participants from the surveys in 2010, 2014 and 2018, n=10,738.Results: The prevalence of recurrent pain defined as pain 'more than once a week' was high: 11.7 % reported recurrent headache, 6.1 % stomachache, and 12.1 % backpain. The proportion who reported at least one of these pains 'almost every day' was 9.8 %. Pain was significantly associated with exposure to bullying at school and low parental SES. The adjusted odds ratio (AOR, 95 % CI) for recurrent headache when exposed to both bullying and low SES was 2.69 (1.75-4.10). Equivalent estimates for recurrent stomachache were 5.80 (3.69-9.12), for backpain 3.79 (2.58-5.55), and for any recurrent pain 4.81 (3.25-7.11).Conclusions: Recurrent pain increased with exposure to bullying in all socioeconomic strata. Students with double exposure, i.e., to bullying and low SES, had the highest OR for recurrent pain. SES did not modify the association between bullying and recurrent pain.

Loneliness has previously been linked to cognitive and attentional bias, and such biases may have a detrimental impact on perceived scholastic self-beliefs. Little is known about the relationship in school-aged adolescents. The current study examined the association between loneliness and scholastic self-beliefs in a nationally representative Danish sample of adolescents (aged 11-, 13- and 15 years, n = 3815, collected in 2014 by the Health Behaviour in School-aged Children study (HBSC)). Through binary logistic regressions, results demonstrated that higher levels of loneliness, measured by a single item and a composite score, were associated with poorer self-reported achievement perception, higher feelings of school dissatisfaction, and greater feelings of school pressure. Results also suggested gender played a moderating role. The current study highlights the importance of loneliness for scholastic self-beliefs, and provides a novel insight by utilising distinct loneliness measures. The implications, in relation to research and practise, are discussed.

Abstract Background: Loneliness in adolescence is a serious threat to quality of life, and it is important to identify possible predictors. The purpose of this study was to examine the association between loneliness and close relationships with parents and friends in a community sample of adolescents, and whether this association varied by sex, age group, and socioeconomic status. Methods: The study used data from the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study in 2010, 2014 and 2018 that included nationally representative samples of students in the age groups, 11-, 13- and 15-year-olds (n=10,425). Loneliness was measured by one item and close relationships with parents was measured by the HBSC Ease of Communication Measure. Multilevel logistic regression was applied to study the associations between ease of communication and loneliness. Stratified analysis and interaction analysis tested the modifying effect of sex on the associations. Results: A large majority (80.1%) of students had close relationships with both parents and friends, 16.3% had close relationships with only one of these parties, and 3.6% with neither any parent nor any friend. The prevalence of loneliness was 6.0%. There was a strong and graded association between loneliness and lack of close relationships. The odds ratios for loneliness were around 8.0 in the groups with the weakest relationships. Stratified analysis showed that girls were more vulnerable to lack of close relationships. Conclusion: The remarkably strong association between lack of close relationships and loneliness – especially for girls – calls for further studies that explore which aspects of loneliness and which aspects of social relationships drive this association. From an intervention point of view, the study suggests that interventions to fight loneliness should include efforts to strengthen social relations among peers at school.

Background: Some studies suggest that favourable socioeconomic circumstances are associated with better parent-child relations but the documentation of such an association is limited and inconsistent. Few studies focused on infancy, few studies relied on objective measurement of parent-infant relations, and few studies included more than one measurement of parent-infant relations in the first year of life. Aims: To report the prevalence of objectively measured problems in parent-infant relations during the first year of life and to examine the association between socioeconomic circumstances and parent-infant relations in an unselected community sample of infants. Methods: Cross-sectional study of a community sample of children from birth to 10 months in 15 municipalities in Denmark, n = 11,765. The exposure variables were population register data about socioeconomic circumstances: (a) parents' education, (b) family composition, (c) parents' origin, and (d) parents' occupational status. The outcome variable was the health visitor's concerns about the parent-infant relation assessed at four home visits from birth to 10 months after delivery. Results: The proportion of children with concerns about the parent-infant relation was 10.5%, 7.8% at one home visit and 2.8% at two or more home visits. Logistic regression analyses showed that all four indicators of socioeconomic circumstances were associated with concerns about the parent-infant relation in the first year of life. Conclusions: The risk of problematic parent-infant relations were significantly elevated among, children of immigrant parents, and children of parents with shorter education and not in education or work.

The aim was to examine whether motor development problems in infancy predicted mental disorders later in childhood, taking a wide array of potential confounder variables into consideration. This longitudinal study included an unselected study population of 33,238 newborn children from the Copenhagen area in Denmark. Data on the predictor variable motor development problems at age 8-10 months was obtained from the community health nurses’ systematic evaluation of the child’s motor development problems during a home visit stored in the Child Health Database. Data on outcome, diagnosed mental disorders before age 8 years, was obtained from the Danish National Patient Register. The study included potential confounders obtained from the Child Health Database, the National Birth Register, and the Civil Registration System. The prevalence of motor development problems at age 8-10 months was 19.3% and the incidence of any diagnosed mental disorder from age 11 months to the 8 th birthday was 4.0%. Motor development problems were associated with an overall increased risk of being diagnosed with a mental disorder before the 8 th birthday, adjusted odds ratio (AOR) 1.47 (1.29-1.67), in particular diagnosed neuro-developmental disorders, AOR 1.77 (1.52-2.06), such as autism-spectrum disorders, AOR 1.63 (1.31-2.03), hyperactivity/ attention deficit disorders, AOR 1.29 (1.03-1.61) and disorders of intellectual disability, AOR 3.28 (2.39-4.49). Conclusion : Motor development problems as early at age 9-10 months are predictive of neurodevelopmental disorders at age 1-8 years. The findings call for clinical attention and more research in the preventive potentials in the community child health care.

Aim: Despite the substantial proportion of adolescents use medicine for common health problems, prevalence of medicine use among adolescents with migrant background have rarely been documented, and the causal pathway continue to be poorly understood. The aim was to examine whether there are migrant differences in adolescents’ medicine use for common health problems, and if feeling safe at school, as a non-exposure to discrimination, explained these differences. Methods: Data derived from the 2006 Danish contribution to the World Health Organization collaborative study Health Behaviour in School-aged Children (HBSC). Medicine use for headache, stomach-ache, difficulties getting to sleep and nervousness and feeling safe at school were self-reported. The population included boys and girls from ages 11 to 15 who were enrolled in the cross-sectional study. Included were 8480 ethnic Danes, 508 descendants and 456 migrants. Logistic regression was applied to assess associations. Multi-level logistic regression was used to assess the independent effect of school cluster. Results: Immigrant girls reported the highest past-month prevalence of medicine use for the four ailments included in the analysis. The highest prevalence of medicine use was found for alleviating headache (54.7%), followed by stomach-ache (30.4%). Among the boys who took medicine for stomach-ache, the odds were 2.11 (1.46-3.05) for descendants and 1.55 (1.00-2.39) for immigrants. Feeling safe at school modifies the effect by reducing the odds to 1.93 (1.32-2.81) for descendants and to 1.30 (0.81-2.07) for immigrants. When simultaneously controlling for the clustering effect of school, feeling safe at school and specific symptoms, the risk of using medicine for stomach-ache was still higher for descendant boys 1.90 (1.26-2.85). Conclusions: Self-reported medicine use for common health problems is high among adolescents with migrant background, particularly among first generations immigrant girls. Feeling safe at school partially mediated the association between migrant background and adolescent’s medicine use. As the process of migration is becoming more and more frequent, our findings suggest that more adolescents may be using medicines for reasons that cannot only be explained by frequency of symptoms alone.

BACKGROUNDUnderweight among adolescents is an important clinical and public health issue. It is associated with adverse health outcomes throughout the life-span and may reflect food poverty, unhealthy eating habits, or some underlying health conditions.OBJECTIVETo study prevalence and trends in underweight among adolescents 1998-2018, to examine social inequality in underweight, and whether social inequality changed over time.METHODSData were derived from 6 cross-sectional school surveys from The Health Behaviour in School-aged Children study in Denmark. The study included 11-, 13-, and 15-year-old schoolchildren in random samples of schools in 1998, 2002, 2006, 2010, 2014, and 2018 (n = 22,177). Underweight was determined by body mass index-for-age thinness grade 2-3 (the Cole and Lobstein method). Socioeconomic status was determined using occupational social class (the Danish OSC Measurement).RESULTSThe overall prevalence of underweight was 3.1% among boys and 5.3% among girls (P < 0.0001) and decreased by age (P < 0.0001) among both boys and girls. The prevalence of underweight was almost stable from 1998 to 2018. There was no observed absolute or relative social inequality in the prevalence of underweight among boys or girls.CONCLUSIONThe prevalence of underweight in 11- to 15-year-olds was significantly higher among girls than boys. The prevalence remained stable from 1998 to 2018. There was no significant association between SES and prevalence of underweight. It is important to elucidate the underlying causes of underweight such as malnutrition, eating disorders, eating problems, loss of appetite, chronic diseases, insufficient knowledge of nutrients effects on bodily functions, and persistent pain.

This paper explores loneliness as it is understood and experienced by adolescents, with a special focus on the importance of their migration status. We recruited students from five schools following a maximum variation sampling scheme, and we conducted 15 semi-structured, individual interviews with eighth-grade adolescents (aged 14–15 years) that were immigrants, descendants, and with a Danish majority background. A thematic analysis was applied with a special focus on differences and similarities in understanding and experiencing loneliness between adolescents with diverse migration status. The results showed more similarities than differences in loneliness. Generally, loneliness was described as an adverse feeling, varying in intensity and duration, and participants referenced distressing emotions. Feeling lonely was distinguished from being alone and characterized as an invisible social stigma. A variety of perceived social deficiencies were emphasized as causing loneliness, emerging in the interrelation between characteristics of the individual and their social context. The results add to the current literature by highlighting that it is not the presence of specific individual characteristics that causes loneliness; instead, loneliness is dependent on the social contexts the individual is embedded in. Differences across migration status were few and related to variations in the adolescents’ individual characteristics. The findings highlight the importance of (1) studying the characteristics of both the individual and the social context in research on the antecedents to adolescents’ loneliness, and (2) applying this perspective in other studies on the importance of migration status.

Chronic backpain among adolescents is important because the prevalence is high, above 10%, and more than 10% of all adolescents experience impacts on important day-to-day activities. Chronic backpain tracks into adulthood and is associated with several health problems. The objective was to study trends in the prevalence of chronic backpain among adolescents 1991–2018, to examine the association with socioeconomic status (SES), and whether this association changed over time. The study used data from eight comparable cross-sectional school surveys of nationally representative samples of 11–15-year-olds in 1991, 1994, 1998, 2002, 2006, 2010, 2014, and 2018, which constitute the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study. The participation rate was 74.6% of the eligible study population, n = 29,952. Chronic backpain was defined as self-reported backpain daily or several days a week during the last 6 months. The prevalence of chronic backpain was 11.1%, significantly increasing from 8.9% in 1991 to 11.7% in 2018. The OR for chronic backpain was 1.20 (95% CI: 1.10–1.31) in middle, and 1.56 (95% CI: 1.41–1.73) in low compared to high SES. Sensitivity analyses with two other cut-points for backpain frequency showed similar associations. Conclusion: Chronic backpain is common among adolescents and the prevalence increased from 1991 to 2018. The prevalence was highest in lower SES families. We recommend increased efforts to prevent chronic backpain.

BACKGROUND Mental disorder in childhood is an important public health issue. We aimed to examine the prospective association between parental education at childbirth and diagnosed mental disorders in young children and explore whether this association was mediated or modified by parent-child relations in infancy. METHODS Prospective cohort study of all newborn was from 2002 to 2010 from 16 municipalities in the capital region of Copenhagen, Denmark, with follow-up until their 8th birthday, N = 40 762. Baseline data included information from national population registers and from health visitors' records at child aged 0 to 10 months. Outcome variable: any mental disorder diagnosed at hospital from age 11 months to 8 years. RESULTS Low parental education was predictive of diagnosed child mental disorder, adjusted odds ratio (AOR) = 1.83 (95% CI 1.49-2.23). Problematic parent-child relation at age 8-10 months was also predictive of mental disorder, AOR = 2.06 (1.57-2.70) but did not mediate the association between parental education and mental disorder. AOR for mental disorders was 3.24 (2.03-5.16 for the combination vocational training and problematic parent-child relation and 2.49 (1.42-4.38) for the combination primary school and problematic parent-child relation. CONCLUSIONS Low parental education and problematic parent-child relation were independent risk factors for diagnosed mental disorders in the age span of 11 months to 8 years.

Chronic backpain among adolescents is important because the prevalence and the burden of disability is high. Chronic backpain tracks into adulthood and is associated with several health problems. The objective was to study trends in the prevalence of chronic backpain among adolescents 1991-2018, to examine the association with socioeconomic status (SES) and whether this association changed over time. The study used data from eight comparable cross-sectional school-surveys of nationally representative samples of 11-15-year-olds in 1991, 1994, 1998, 2002, 2006, 2010, 2014 and 2018, the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study. The participation rate was 88.0%, n=29,952. Chronic backpain was defined as self-reported backpain daily or several days a week during the last six months. The prevalence of chronic backpain was 11.1%, significantly increasing from 8.9% in 1991 to 11.7% in 2018. The OR for chronic backpain was 1.20 (1.10-1.31) in middle and 1.56 (1.41-1.73) in low compared to high OSC. Sensitivity analyses with two other cut-points for backpain frequency showed similar associations. Conclusion: Chronic backpain is common among adolescents and the prevalence increased from 1991 to 2918. The prevalence was highest in lower SES families. We recommend increased efforts to prevent chronic backpain.