The European Journal of Public Health Advance Access originally published online on April 26, 2006
The European Journal of Public Health 2006 16(5):542-548; doi:10.1093/eurpub/ckl012
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Adolescent health |
Perceived financial difficulties and maladjustment outcomes in adolescence
Sari Fröjd1, Mauri Marttunen2,3, Mirjami Pelkonen3, Bettina von der Pahlen3,4 and Riittakerttu Kaltiala-Heino1,5
1 Tampere School of Public Health, University of Tampere, Tampere, Finland
2 Department of Adolescent Psychiatry, University of Kuopio, Kuopio, Finland
3 National Public Health Institute, Finland
4 University of Åbo Akademi, Turku, Finland
5 Department of Adolescent Psychiatry, Tampere University Hospital, Finland
Correspondence: Sari Fröjd, MSc (Public Health), Tampere School of Public Health, FIN-33014 Tampereen yliopisto, Finland, tel: +358 3 215 6111, fax: +358 3 215 6057, e-mail: sari.frojd{at}uta.fi
Received September 27, 2005, accepted December 8, 2005
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Abstract |
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Background: Studies using traditional SES indicators in strictly adolescent populations have usually failed to find class differences in adolescent mental health. The present study aimed to find out whether there is an association between adolescent perceived financial difficulties of the family and adolescent maladjustment, and to explore the possible sex differences in this association. Methods: School-based survey on 3278 ninth grade students (15–16 years old) in two economically well developed Finnish cities. Results: One-fifth of the adolescents reported that their family had financial difficulties in the previous 12 months. Perceiving financial difficulties was significantly more common among girls than boys. Perceived financial difficulties were associated with known risk factors of poverty and with depression and harmful drinking patterns in both sexes. Adjusting for parental educational levels, parental unemployment and family structure did not change the significant association with maladjustment outcomes. Additional adjustment with comorbidity, however, levelled out the significance of the association of perceived financial difficulties and harmful drinking patterns in boys. Conclusion: While adolescent perception of financial difficulties is probably associated with the objective financial situation of the family it may also be an indicator of the psychological meaning attached to the situation and should thus be considered a possible risk factor for adolescent maladjustment in clinical practice.
Keywords: adolescent depression, adolescent psychology, family, social class
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Introduction |
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While social class differentials in morbidity and mortality are found in childhood and adulthood, they seem to diminish or disappear in adolescence. Studies using the traditional ways of measuring socioeconomic status have usually found weak associations or no associations at all between SES and adolescent mental health outcomes.1 The recent nationwide British survey of child mental health found strong univariate associations between several SES indicators and child psychiatric disorders but they disappeared in multivariate analysis.2 Some studies, however, suggest even widening of inequalities from childhood to adolescence, when social inequalities are interpreted more broadly than by a social class based definition.3
The traditional way of measuring the economic well-being of a family is to measure the characteristics of the father, most often his educational level, occupation or labour force status.4 Recent studies have attempted to capture the concept of perceived economic hardship. The reasoning behind the use of subjective methods is to investigate stress experienced due to the perceived disparity between needs and resources. The findings of studies using the parents as informants of financial stress have suggested that perceived economic stress affects the parents' emotions and parenting strategies thus detrimentally altering the developmental environment of the offspring.5–7
Financial stress in the family may also have a direct effect on the psychological well-being of the offspring.8 For the children, financial difficulties are an independent and uncontrollable life event. In a recent study by Conger et al.9 parent reported economic pressure influenced the degree the adolescents felt that they were in control of the events in their lives through adolescent perceptions of family hardship.
There are only few studies addressing financial stress reported by adolescents themselves. However, there are studies suggesting that adolescents and their parents have different perceptions of the financial situation of the family. Moreover, the perceptions of the adolescents seem to have a stronger association with adolescent mental health and substance use than the perceptions of the parents.10 Adolescent perceptions of financial difficulties in the family have been found to be associated with both internalizing and externalizing behaviours.8,10
Many studies on financial stress have been carried out in special economic circumstances, such as an economic depression, or with low-income or minority populations. The perceptions and effects of economic adversities may, however, vary between different regions according to the general amount of economic adversity, as suggested by Forkel and Silbereisen.6 In general populations, the health-affecting factor may thus be the relative economic deprivation, not only the low income per capita or other objective measure of economic disadvantage. In order to study the concept of perceived financial difficulties in middle adolescence, we examined the associations of known causes of economic disadvantage (family structure and unemployment) in Finland and reporting of financial difficulties among 15- to 16-year-old general population of two economically well developed cities.
We hypothesized, that perceived financial difficulties are directly associated with both internalizing (depression) and externalizing (harmful drinking patterns) maladjustment outcomes in adolescence. Moreover, since the issue of sex differences in the associations between perceived financial difficulties and maladjustment has not been adequately addressed in the literature, we also explored this aspect.
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Methods |
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Procedures
Ninth grade students (aged 15–16 years) of all the Finnish-speaking secondary schools in two Finnish cities, Tampere (200 000 inhabitants) and Vantaa (180 000 inhabitants) completed a person-identifiable questionnaire during a school lesson supervised by a teacher. The parents of the subjects were informed in advance by a letter, but parental consent to participation was not required since the Finnish legislation on medical research allows a 15-year-old subject to consent alone. For students absent from school on the original survey day, a separate opportunity to participate was offered in the school within a couple of weeks of the original data collection. For students not present on either occasion, the questionnaires were sent by mail.
Students in the ninth grades of the participating schools totalled 3809. The response rate in Tampere was 96% and in Vantaa 92%. Age <15, obvious facetiousness, or too many incomplete answers caused 531 (14%) respondents to be excluded. Thus, the final sample consisted of 1609 girls and 1669 boys. The mean age of the respondents was 15.5 (SD 0.4).
Measures
Depression
A Finnish modification11 of the 13-item Beck Depression Inventory12 was used to assess depression. The Beck Depression Inventory is a widely used scale with established validity and reliability in both adult and adolescent samples.13,14 The Finnish version of the BDI-13 showed good psychometric properties in a large population sample of adolescents.15 The 13 items indicate different feelings, cognitions and physical symptoms related to depression. Response alternatives indicating increasing severity of symptoms are scored 0–3 (three indicating the greatest severity). The scores of all 13 items were summarized to obtain a sum-score of depressiveness (range 0–39) points. A cut point of eight indicates moderate to severe depression,12 and this was used to define caseness in the present study. When only one item was unanswered, missing items were replaced with the mean value of the subject's responses to the other items of the scale. Cases with more than one unanswered item (n = 14) were excluded.
Harmful drinking patterns
In the present study we illustrate harmful drinking patterns with frequency of drinking to the point of intoxication. Frequency of drinking to the point of intoxication was elicited: ‘How often do you drink alcohol until you are really drunk’? (once a week or more often/approximately once or twice a month/less often/never). Lintonen and Rimpelä16 have shown that Finnish adolescents from age 14 are well aware of the concept of being ‘really drunk’ and have a perception highly correlated with their estimated blood alcohol concentration. For the analyses the variable was dichotomized to once a week or more often yes/no (where the answer ‘no’ included all the other alternative frequencies of drinking to the point of intoxication and also abstaining).
Perceived financial difficulties
Perceived financial difficulties were assessed with one item of the Life Events Checklist (LEC).17 The adolescents were asked to indicate if financial difficulties had occurred in the family during the past 12 months (yes/no).
Traditional SES indicators
Family structure
The adolescents were asked, whether their family consisted of mother and father/mother and stepfather/father and stepmother/mother only/father only/some other legal guardian. In the univariate analyses, family structure was divided into four categories: intact family/single parent family/step parent family/apart from parents. For the multivariate analyses a dichotomous variable was created: non-intact family (=single or step-parents, other legal guardian) yes/no.
Parental unemployment
The adolescents were asked to indicate if their parents had both been employed/one of the parents had been unemployed/both of the parents had been unemployed during the last year. For the multivariate analyses the variable was dichotomized into parental unemployment yes/no.
Paternal and maternal educational levels
Parental educational levels were ascertained by asking the highest level of education that the mother had completed and the highest level the father had completed. The alternatives were comprehensive school only/vocational school/college level/university degree. For multivariate analyses a dichotomous variable was created: low educational level (= comprehensive school only) yes/no.
Statistical methods
Frequencies (n, %) of the characteristics of the sample were calculated. Significance of sex differences in frequencies of the outcome variables were tested with chi square statistics.
The risk for reporting financial difficulties was ascertained according to parental educational levels, parental unemployment and family structure variables using unadjusted logistic regression models.
Logistic regression models were used to test univariate associations of the maladjustment outcomes with perceiving financial difficulties, traditional SES indicators and risk factors for poverty. Multivariate associations were tested by entering perceived financial difficulties and all the covariates (low parental educational levels, parental unemployment, non-intact family structure) in a stepwise logistic regression model (forward LR) first with depression and then with harmful drinking patterns as the dependent variable (Model 1). Finally, we added depression as a covariate into the model with harmful drinking patterns as the dependent variable and vice versa, to control for comorbidity (Model 2).
All logistic regression models were made separately for boys and girls. Analyses were carried out with the SPSS11.0 software package.
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Results |
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Characteristics of the sample
One-fourth of the families had experienced unemployment of one or both parents during the last year (table 1). The BDI scores for girls indicated depression twice as often as the scores for boys (14% versus boys 7%; P < 0.001), whereas boys reported harmful drinking patterns more often than girls (5% versus 3%; P = 0.054). Nearly a fifth of the adolescents reported that their family had financial difficulties during the previous 12 months, girls more often than boys (22% versus 15%; P < 0.001).
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Associations of perceived financial difficulties with risk factors for poverty and with traditional SES indicators
Perceived financial difficulties were associated with risk factors for poverty in Finnish families with children: unemployment and single parent family. Low parental education was also significantly associated with reporting financial difficulties in both sexes (table 2).
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Associations of perceived financial difficulties and traditional SES indicators with maladjustment outcomes
The traditional SES indicators and perceived financial difficulties were almost without exception associated with depression and harmful drinking patterns in both boys and girls when entered in logistic regression each alone (tables 3 and 4: unadjusted). Perceived financial difficulties were significantly associated with depression and harmful drinking patterns in both sexes even when controlling for traditional SES indicators (tables 3 and 4: Model 1). Of the traditional SES indicators, family structure was significantly associated with male depression and maternal educational level with male frequent drunkenness, whereas parental unemployment was associated with female depression.
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When comorbidity was also adjusted for (Model 2), the association between perceived financial difficulties and depression was sustained in both sexes, whereas the association between perceived financial difficulties and harmful drinking patterns lost significance in boys. Educational level of the mother was significantly associated with harmful drinking patterns in boys and family structure and parental unemployment were significantly associated with female depression.
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Discussion |
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The hypothesis that perceived financial difficulties are directly associated with both internalizing (depression) and externalizing (harmful drinking patterns) maladjustment outcomes in adolescence was supported. The association persisted even after controlling for parental educational levels, parental unemployment and family structure. The association of perceived financial difficulties and maladjustment was extremely strong in girls. In boys, adjusting for depression resulted in perceived financial difficulties loosing the significant association with harmful drinking patterns, which may indicate, that depression mediates the association between perceived financial difficulties and harmful drinking patterns in males.
Our findings are in line with previous findings with adolescents as informants of perceived economic stress in the family being associated with the offspring's emotional problems,8 general psychiatric morbidity and substance use.10 Our results are also in agreement with those of Tiet et al.,18 who used more detailed diagnostic categories and found a negative change in the financial situation of the parents to be related to both internalizing and externalizing disorders.
Are perceived financial difficulties a measure of economic well-being? In the present study, perceived financial difficulties were associated with factors known to affect the financial situation of Finnish families with children: unemployment and single parenthood.19,20 This concurs with the finding of Wadsworth and Compas,8 who suggested that adolescent reports of higher levels of economic stress were associated with lower SES, and Conger et al.,9 who found adolescent perceptions of money problems to be correlated to objective economic circumstances (income per capita) of the family. In a country with a highly educated population, relatively even income distribution and universal social benefits, subjective measures of economic pressure could reflect the reduced material resources of the family more accurately than the occupational or educational SES of the parents. For example, during the 1990's recession, a steep decline in household income was reported across all social classes in Finland.21
Our finding of a significant preponderance of girls reporting perceived financial difficulties still calls for an explanation. The finding differs from the study by DeHaan and MacDermid,22 who found no sex differences in adolescent reported economic deprivation (measures of current and past levels of income and ability to pay bills and meet basic needs). It is, however, in line with the Swedish study by Hagquist23 reporting that girls were worried about the finances of the family almost twice as often as boys. This may indicate that perceived financial difficulties are not simply a measure of the financial situation of the family, but also a reflection of the psychological meaning associated with that situation.
Perceived financial difficulties could also measure the relative economic deprivation of the family in the eyes of the adolescent offspring. As Dittmar and Pepper24 suggest, adolescents may have materialistic values: they favour a person who owns expensive possessions. Moreover, perceived economic stress has been suggested to have a detrimental effect on life satisfaction and sense of mastery of adolescents.10 The adolescent's experience of inferior resources compared with peers and helplessness with respect to the opportunities to change the situation may thus explain the association between perceived financial difficulties and maladjustment found in the present study.
Finally, perceived financial difficulties are a probable indication of economic stress. Conger et al.9 suggest that one pathway from family economic hardship to adolescent distress goes through adolescent perceptions of family hardship and adolescent hardship experiences. Adolescent perception of family hardship reduces adolescent's sense of control9 and is a major cause of worry.23,25 In other words, economic hardship may cause stress in two ways. The adolescent is aware that the parents are troubled by economic worries, which in turn worries the adolescent. On the other hand, the adolescent him/herself has experiences of financial hardship (such as being unable to purchase things or to engage in recreational activities with peers), which diminishes his/her sense of control and also makes him/her feel inferior to peers.9,23
Specific SES indicators measure different dimensions of SES, which in turn may act differentially causing some health outcomes but not others, as suggested by Goodman.26 In recent Finnish studies using parental education27 or paternal occupation28 as measures of adolescent socioeconomic status, the associations of socioeconomic status and frequent alcohol use have been virtually non existent, whereas economic pressure (cutbacks in family expenditures and other means of making ends meet) has been reported to correlate significantly with child externalizing problems.25 The present study indicates, that there are also sex differences in the associations of different SES indicators and adolescent maladjustment; a finding in agreement with a study of Kaltiala-Heino et al.29 where parental educational level was associated with female depression only.
Our sample was representative of the middle adolescents of two medium-sized Finnish cities, the response rate was excellent, and the prevalence of the maladjustment outcomes were comparable to those found in recent Finnish adolescent population studies.30,31 Although not comparable with a diagnostic interview, the depression scale used in this study is a standardized instrument previously tested in adolescent populations14 and also in Finnish adolescents.15 The measure of weekly drunkenness illustrating harmful drinking patterns has also been validated in a sample of Finnish adolescents and has been used in several large surveys of school-aged children in Finland.16
The following limitations must, however, be kept in mind when evaluating the present findings. Firstly, we used a single LEC item to measure perceived financial stress and had only adolescent reported data on the SES indicators of their parents. Lien et al.,32 however, suggest adolescent reports of parental socioeconomic status to be in good agreement with parental reports. Secondly, our sample was from two cities, and while some adolescents might have been from the neighbouring rural areas (attending school in town), the findings may not be generalized to rural populations. Thirdly, we had no information about the parental mood or alcohol consumption, which could mediate the association of financial difficulties with the psychological adjustment of the adolescents. The direction of causality cannot be determined using a cross-sectional design.
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Conclusions |
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Perceiving financial difficulties is quite common among adolescents even in a welfare state like Finland. Social and healthcare professionals working with families should consider the financial difficulties in the family as a possible risk factor for maladjustment in the offspring. Possible ways of preventing maladjustment are discussions of the psychological meaning of economic hardship (helping the adolescent to see his/her situation in a new way, reducing feelings of inferiority or shame) and giving the adolescent tools to cope with situations arising as a consequence of financial difficulties (conflicts with parents, conflicts between parents and difficulties in socializing with peers).
Key points
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Acknowledgments |
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The research project was funded in part by the Yrjö Jahnsson Foundation.
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References |
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