School and School Environment as a Determinant for Psychosomatic Complaints

During early adolescence individuals must cope with the biological challenges associated with puberty and the psychological challenges of increased identity differentiation. Another potential source of stress is the school environment. Complaints regarding school may reflect in part problems in adapting to school demands, which in turn, can lead to the emergence of psychosomatic complaints. We investigated if students' perceived school environment and adjustment to school are associated with psychosomatic complaints.

The international WHO Health Behavior in School-aged Children (HBSC) survey 2002 was conducted in 35 countries of Europe, North America, and Israel. The data of 162306 adolescents (11–15y) were analyzed. Structural equation model analyses were based on associations between social school climate, pressure by schoolwork, academic achievement, liking school and psychosomatic complaints (HBSC-SCL) across gender and age.

The specified model fitted the data well (RMSEA=0,05). A large proportion of the variance in psychosomatic complaints could be attributed to the school variables (R²=0,48). Girls' psychosomatic complaints seemed to be more strongly affected by the school environment than boys'. Higher age reduced the strength of the relationship between school pressure and school adjustment. In all subgroups the relationship between better school perceptions and less psychosomatic complaints were supported by the analyses.

The observed relationships revealed the importance of school for psychosomatic complaints. Despite the cross-sectional study design but for the sake of presenting a clear argument we considered school as the determinant and health as the outcome–acknowledging that the relationships are likely to be more complex and dynamic. Assuming that the specified model holds true, there are strong effects of school environment via school adjustment on psychosomatic complaints, indicating the need to improve the school environment.