Psychosomatic Symptoms: Resilience as a Protective Factor in Adolescents. Observational, Descriptive, Cross-Sectional, and Multicenter Study

doi:10.21203/rs.3.rs-1434643/v1

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Psychosomatic Symptoms: Resilience as a Protective Factor in Adolescents. Observational, Descriptive, Cross-Sectional, and Multicenter Study

https://doi.org/10.21203/rs.3.rs-1434643/v1

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Background

Psychosomatic symptoms—clinical manifestations without a clear pathological origin—have a high prevalence in adolescents. However, most studies are oriented towards the search for risk factors and very few have approached the subject by examining which elements may be protective. The objective of this current work was to identify whether there is an association between the presence of psychosomatic symptoms and the capacity for resilience in adolescents.

Methods

This was an observational, descriptive, cross-sectional, and multicenter study carried out at five different schools in Cuenca (Spain). The sample comprised 844 adolescents aged 15 to 18 years who were in the 3rd or 4th years of compulsory secondary education or the 1st or 2nd years of the baccalaureate. At each academic level, groups were randomly selected for administration of the Psychosomatic Problems Scale and 10-Item Connor–Davidson Resilience Scale (to determine psychosomatic symptoms and resilience, respectively); sociodemographic data were also recorded.

Results

Girls overall, and adolescents aged 17–18 years, presented significantly higher psychosomatic symptoms. Being more resilient was negatively correlated with all the psychosomatic symptoms. The strongest correlation was between ‘felt sad’ and ‘concentrating difficulties’ and the multivariate analysis, which controlled for sex and age, predicted fewer psychosomatic symptoms among the most resilient individuals.

Conclusions

Psychosomatic symptoms are frequently observed in the adolescent population and are often expressions that make emotional distress visible. The capacity for resilience positively affected emotional well-being and reduced the risk of presenting psychosomatic symptoms in our study population.

adolescents

psychosomatic symptoms

resilience

emotional distress

Adolescence is a phase of life characterized by substantial physical, psychological, social, and emotional changes that lead to increased vulnerability [1]. Despite being free of diseases of older age, adolescents are still undergoing the process of maturation and change and face demanding educational requirements and challenges derived from intra-family problems and/or conflicts with peers. This potentially precarious situation puts the subjective well-being of adolescents at risk and makes them more susceptible to experiencing psychosocial distress, which can lead to psychosomatic health complaints. [2].

The term psychosomatic refers to psychophysiological responses to stimuli that may be present in different contexts. Some research uses psychosomatic symptoms as indicators of health and well-being [3] and possible psychological difficulties [4]. These symptoms do not have a clear organic cause and their differential diagnosis is sometimes complicated. Moreover, there is some evidence that they are associated with increased psychological distress and are important components of mental disorders [5].

The medical histories of many adolescents include the presence of recurrent headaches, stomach pain, gastrointestinal symptoms, problems with sleep, appetite, concentration, mood, fatigue, dizziness, and anxiety, etc., which can cause notable general health problems and are usually accompanied by neurovegetative clinical signs such as sweating, paleness, chills, and nausea, among others [6]. Studies in the adolescent population indicate that between 5% and 30% present psychosomatic symptoms on a weekly basis [7]. Importantly, the presence of these psychosomatic problems is associated with over-attendance of health services [8], an increased risk of undergoing diagnostic tests, and even some cases of hospitalization and treatments that, in addition to being ineffective, can become iatrogenic [9].

Given the frequency and relevance of this problem, there is a strong academic interest in researching it. Previous studies have focused on the possible risk factors that can affect the psychosomatic health of adolescents and how these can interchange between biological and psychosocial etiologies. The factors that can act as triggers include physical problems, treatments, psychosocial stressors, and childhood trauma [9]. These factors also include very marked personality traits because they can make it difficult to emotionally and behaviorally adapt to the problems and stresses of daily life [10]. Genetic, family, and social factors in educational contexts—such as being a victim of bullying [11]—lifestyles, and risky behaviors such as smoking and drinking [12], are other examples.

However, less is known about the protective factors that can help adolescents to adapt and overcome difficulties. In this sense, although scarce, previous reports have suggested that resilience can be a protective factor against adversity since it is synonymous with resistance and reduced vulnerability to stressors [13]. Resilience is a construct that can be defined as the ability to respond and develop in the face of stressful life events [14], or more generally, the ability to present adaptive responses to adverse conditions [15]. It can also be considered as a process of overcoming the negative effects of exposure to risks or successfully coping with traumatic experiences [16].

Some studies consider it as a personal resource that favors recovery in the face of adversity, uncertainty, and conflict or failure [17]. Other work in the academic literature highlights the role of resilience as an adaptive quality that allows adolescents to grow despite experiencing stressful situations [18]. Furthermore, it has also been shown that personality traits such as emotional instability are negatively associated with resilience while extraversion and self-confidence was associated with greater resilience [19]. Considering these precedents, this present work aimed to identify if there is any association between psychosomatic symptoms and the capacity for resilience in adolescents.

An observational, descriptive, cross-sectional, and multicenter study was carried out in 5 secondary education centers in Cuenca (Spain). Adolescents aged 15 to 18 years who were in the 3rd or 4th years of compulsory secondary education (ESO in its Spanish acronym), or the 1st or 2nd years of the baccalaureate, were included. At each academic level, groups were randomly selected for administration of the questionnaires. The inclusion criteria were belonging to one of the classes randomly selected for study and provision of informed consent to participation (by the legal guardian for minors or the adolescent themselves when aged over 18). The exclusion criteria were being unable to read in Spanish or having a mental or physical illness that prevented individual completion of the questionnaire.

The study population included 2500 individuals; the sample size required was calculated as 526 individuals (CI = 99% and e = 2%), although we expanded the sample because we expected possible losses. Only adolescents for which informed consent had been granted participated in the study. The study protocol was approved by the Castilla-La Mancha Community Board Ministry of Education, Culture, and Sports and by the respective parties at the participating education centers. After obtaining this approval, a letter was sent to all the guardians involved, explaining the objectives of the study, and requesting their collaboration to allow their children to participate.

Instruments

A self-administered questionnaire was used which included both sociodemographic data such as age and sex and the following assessment scales:

- The Psychosomatic Problems Scale (PSP) [20]. This instrument includes 8 common problems: concentrating difficulties, sleeping difficulties, headache, stomach ache, felt tense, little appetite, felt sad, and giddy. The 8 items on the questionnaire are evaluated using a Likert-type scale with 5 alternatives (never, seldom, sometimes, often, and always) which range from 0 to 4, with lower scores indicating the presence of fewer psychosomatic symptoms. The values of the items were summed to give an index score ranging from 0 to 32, with the highest values being indicative of more frequent symptoms. The scale showed good internal consistency (Cronbach α = 0.76).

- The abbreviated 10-Item Connor–Davidson Resilience Scale (CD-RISC) developed by Connor and Davidson [21] and validated in its Spanish version by Serrano et al. [22]. This scale includes 10 items valued using a Likert-type scale measuring frequency from 0 (never) to 4 (almost always), with higher scores representing greater the resilience. The Cronbach α for the CD-RISC was 0.84.

Data analysis

Data analysis and processing was undertaken using SPSS software (version 23.0; IBM Corp., Armonk, NY). Student t-tests were used to discern any differences between the participant sex and age groups (15–16 and 17–18) with respect to the presence of psychosomatic symptoms. We applied Pearson correlation tests to check the associations between psychosomatic symptom scores and resilience. Finally, different linear regression models were performed (one for each psychosomatic symptom) using sex and age as control variables to assess whether being more resilient could predict the presentation of psychosomatic symptoms.

A total of 844 adolescents with a mean age of 16.3 ± 1.0 years participated in the study; 55.7% of the participants were female; 65.8% were in the 3rd or 4th year of the ESO and 34.2% were in the 1st or 2nd year of the baccalaureate. As shown in Table 1, the girls showed significantly higher levels of psychosomatic symptoms than the boys. The most common symptoms in both sexes were: ‘concentrating difficulties,’ ‘felt tense,’ ‘headache,’ and ‘felt sad.’ The older group had significantly higher scores for all the psychosomatic symptoms, except for ‘little appetite.’ In all the established sex and age groups, the psychosomatic symptom with the highest score was ‘concentrating difficulties,’ which reached mean values of 1.7 to 2.0 (range = 0–4). Regarding resilience, boys presented higher values than girls and no statistically significant differences were found as a function of age.

Table 1

Psychosomatic symptoms and resilience by sex and age
	Mean [SD]	Boys Mean [SD]	Girls Mean [SD]	p	Age 15–16 Mean [SD]	Age 17–18 Mean [SD]	p
Psychosomatic symptoms	9.5 ± 4.7	7.7 ± 4.2	11.0 ± 4.6	.000	8.8 ± 4.7	10.5 ± 4.6	.000
- Concentrating difficulties	1.9 ± 0.9	1.8 ± 0.9	1.9 ± 0.9	.006	1.7 ± 0.9	2.0 ± 0.9	.000
- Sleeping difficulties	1.1 ± 1.0	0.9 ± 1.0	1.2 ± 1.0	.001	1.0 ± 1.0	1.2 ± 1.0	.010
- Headache	1.2 ± 0.9	0.9 ± 0.9	1.4 ± 0.9	.000	1.1 ± 0.9	1.4 ± 0.9	.000
- Stomach ache	1.1 ± 0.9	0.8 ± 0.7	1.3 ± 0.9	.000	1.0 ± 0.8	1.2 ± 0.9	.004
- Felt tense	1.3 ± 1.0	1.1 ± 1.0	1.4 ± 1.0	.000	1.2 ± 1.0	1.5 ± 1.0	.000
- Little appetite	0.9 ± 0.9	0.6 ± 0.8	1.2 ± 1.0	.000	0.9 ± 1.0	0.9 ± 0.9	.322
- Felt sad	1.1 ± 1.0	0.9 ± 0.9	1.4 ± 1.0	.000	1.0 ± 1.0	1.3 ± 1.0	.001
- Giddy	0.7 ± 0.8	0.4 ± 0.6	0.8 ± 0.9	.000	0.6 ± 0.8	0.7 ± 0.8	.003
RESILIENCE	28.19 ± 6.71	29.36 ± 6.51	27.26 ± 6.73	.000	28.29 ± 6.84	28.06 ± 6.55	.627
* Student t-test

As shown in Table 2, a negative correlation was found between all the psychosomatic symptoms and resilience in the global sample; in other words, as resilience increased, psychosomatic symptoms decreased. The correlation was higher for ‘felt sad,’ ‘concentrating difficulties,’ and ‘giddy’ (r = − .363, r = − .254, and r = − .219, respectively; p < .01). For the boys, the association was not statistically significant for ‘stomach ache,’ ‘felt tense,’ or ‘little appetite,’ while in girls, the global index and all the symptoms except ‘headache’ and ‘little appetite’ were negatively correlated with resilience and the correlation power was moderate for ‘felt sad.’

Table 2

Pearson correlations between resilience and psychosomatic symptoms
	RESILIENCE	RESILIENCE	RESILIENCE
PSYCHOSOMATIC SYMPTOMS	Total	Boys	Girls
Overall psychosomatic symptoms	−.327^**	−.218^**	−.349^**
- Concentrating difficulties	−.254^**	−.160^**	−.312^**
- Sleeping difficulties	−.143^**	−.132^*	−.123^**
- Headache	−.167^**	−.165^**	−.113^*
- Stomach ache	−.156^**	−.098	−.127^**
- Felt tense	−.178^**	−.095	−.207^**
- Little appetite	−.113^**	−.029	−.099^*
- Felt sad	−.363^**	−.218^**	−.420^**
- Giddy	−.219^**	−.133^*	−.227^**
^** p < 0.01

After uncovering evidence of correlations between resilience and psychosomatic symptoms, several multiple linear regression models were performed (one for each psychosomatic symptom) using sex and age as control variables to determine the predictive value of resilience on these factors (Table 3). All the variables were entered into the different equations except for age in the ‘little appetite’ model. Being more resilient predicted fewer psychosomatic symptoms in all the models, but those that best explained the variance associated with resilience were the models performed for ‘concentrating difficulties’, with an R² of 9.6%, beta of − 0.239, and an increase in R² of 5.6%, and ‘felt sad’ with an R² of 18.2%, beta of − 0.328, and an increase in R² of 10.5%. Female sex explained a significant increase in the variance in all the psychosomatic symptoms and especially the ‘headache,’ ‘stomach ache,’ ‘giddy,’ and ‘little appetite’ symptoms.

Table 3

Linear regression models for each psychosomatic symptom
Linear regression steps	B	Standard error		R²	Δ R²	p
Model 1. Total psychosomatic symptoms				23%
Sex	2.899	0.295	0.302		11.5%	.000
Age	0.861	0.137	0.190		Δ3.8%	.000
Resilience	−0.195	0.022	−0.274		Δ7.4%	.000
Model 2. Concentrating difficulties				9.6%
Sex	0.118	0.063	0.062		3%	.062
Age	0.150	0.029	0.167		Δ1%	.000
Resilience	−0.034	0.005	−0.239		Δ5.6%	.000
Model 3. Sleeping difficulties				4.2%
Sex	0.219	0.073	0.102		1.4%	.003
Age	0.110	0.034	0.109		Δ1.3%	.001
Resilience	−0.020	0.005	−0.124		Δ1.5%	.000
Model 4. Headache				9.6%
Sex	0.452	0.065	0.230		6.1%	.000
Age	0.127	0.030	0.137		Δ2%	.000
Resilience	−0.019	0.005	−0.127		Δ1.5%	.000
Model 5. Stomach ache				11.6%
Sex	0.525	0.060	0.289		9.2%	.000
Age	0.094	0.028	0.110		Δ1.3%	.001
Resilience	−0.014	0.004	−0.107		Δ1.1%	.001
Model 6. Felt tense				7.4%
Age	0.172	0.034	0.167		2.8%	.000
Sex	0.274	0.074	0.125		Δ2.2%	.000
Resilience	−0.025	0.005	−0.154		Δ2.4%	.000
Model 7. Little appetite				9.2%
Sex	0.560	0.065	0.284		8.7%	.000
Resilience	−0.010	0.005	−0.069		Δ0.5%	0.039
Model 8. Felt sad				18.2%
Sex	0.421	0.066	0.202		6.3%	.000
Age	0.107	0.031	0.109		Δ1.4%	.000
Resilience	−0.051	0.005	−0.328		Δ10.5%	.000
Model 9. Giddy				9%
Sex	0.329	0.056	0.194		4.9%	.000
Age	0.063	0.026	0.079		Δ0.7%	.017
Resilience	−0.023	0.004	−0.186		Δ3.4%	.000

To the best of our knowledge, this is the first study in a population of adolescents to examine the association between psychosomatic symptoms and resilience. Our data indicate that psychosomatic symptoms were more frequent in girls and older adolescents and that, in both sexes, increased resilience was associated with being less affected by psychosomatic symptoms. Young people often experience different challenges that can call into question their ability to cope, making the presentation of psychosomatic symptoms more frequent in the adolescent population. Our data indicating increased psychosomatic symptoms in girls and older adolescents coincides with the findings previously published in the academic literature [23]. Both boys and girls have similar problems at early ages but the differences according to sex become more evident in adolescence. The age range included in our sample was narrow (15 to 18 years) but nonetheless, we found significant differences between the groups aged 15–16 and 17–18 years for all the psychosomatic symptoms except for ‘little appetite’.

During adolescence, boys and girls experience different but specific challenges related to sex and age as part of their development. Thus, it is likely that pubertal processes are a common cause of many of the psychosomatic complaints in girls [24] because their physical changes are more drastic as the result of menstruation and hormonal fluctuations [25]. The consequence of these factors may be a poorer perception of quality of life among adolescent girls; this would tie in with some studies reporting that psychosomatic complaints are clinical forms of the expression of emotional problems that negatively affect quality of life and which can become especially visible in lower mood states and with the increased perception of stress [26].

Our results indicate that ‘concentrating difficulties’ and ‘felt tense’ were the symptoms that occurred most frequently in both sexes and age groups. The joint presence of these symptoms could be related to a depressive state [27], which more commonly affects women [28]. Indeed, some studies have suggested that, in the absence of disease, depression may be the general consequence of stress in the academic environment, with stress increasing as the demands on educational competence increases [29]. Moreover, the literature indicates that psychological well-being is positively correlated with academic results [30]. Stress related to academic performance can translate into psychosomatic complaints when adolescents feel tired because the requirements of a given situation exceed their resources and capacities [31]. If this imbalance is very pronounced, distress appears, resulting in negative thoughts and emotions and a decrease in academic results [32].

In this sense, researchers have indicated that prolonged stress can facilitate the presence of psychosomatic symptoms [33]. The influence of a depressed mood on other health problems can be explained because negative affective states directly affect physiological functioning and therefore also influence the development of psychosomatic symptoms [34]. It is very important to heed these symptoms during adolescence because they can affect both activities in the academic environment [class attendance, motivation towards learning, grades, etc.] as well as the perception of physical and psychological health, self-esteem, and the sense of accomplishment, all of which can have important implications on the health of adolescents, sometimes for life [35].

In terms of resilience, similar to our study, the limited research that has addressed differences according to sex and age among healthy adolescents to date suggests that boys fare significantly better than girls [36]. However, regardless of sex, the regression models we created (which controlled for age and sex) showed that the capacity for resilience was a good predictor of fewer psychosomatic symptoms in our population, with the strongest associations being found between ‘felt sad’ and ‘concentrating difficulties.’ Resilience can be considered as a personal resource, a positive characteristic that helps individuals to adapt to changes, mitigates the effects of stress, and minimizes depressive states [37]. Studies indicate that resilience is related to subjective well-being and that stressful events can influence feelings of sadness. However, it is not the quantity or number of stressful events that is important but rather, their interpretation; in other words, how they are perceived, thought about, and responded to [38]. This allows us to conclude that this ability is not only relevant to improving mental health, but also to help cushion and minimize the negative consequences of stress [39].

Sadness is felt with great intensity during adolescence because the biological and psychosocial life events that occur in this period are magnified and ruptures occur that are experienced with great drama [40]. Adolescents use their life skills to regulate these feelings, however, some find it difficult to cope with these states of sadness and so they are often associated with the appearance of pathologies such as depressive disorders or anxiety [41]. Sadness is one of the main symptoms of depression. Indeed, some studies predict that depressive disorders will become a global disease burden over the coming decades [42]. Depression in adolescents is complex and its presence places them at a higher risk of suicide than adults, leads to social deficiencies such as a tendency to consume toxic substances, and can also be at the root of educational deficiencies that may have negative consequences for their adult lives [42].

Furthermore, difficulty concentrating can affect the achievement of pedagogical objectives and, if it persists over time, can lead to academic failure with implications for the biopsychosocial development of adolescents and their environments. This can lead to a reduction in opportunities for them to participate in the social, cultural, and economic dimensions of society. In fact, some studies have indicated that resilience is a significant positive predictor of academic performance [43]. Thus, ideally, a positive social environment should be fostered both in educational centers and in family environments during this complex stage of life. Nonetheless, promoting resilience could increase the capacities and resources available to adolescents to cope with demanding situations and to develop alternative responses to problems that affect their mental health.

In conclusion, our study showed that in our cohort, resilience was a protective factor against the presence of psychosomatic symptoms. Moreover, these symptoms may be the expression of emotional distress if the internal resources available to adolescents exceed their capabilities. In this sense, strengthening resilience could help reduce psychosomatic problems and improve emotional well-being. Our results may also have educational implications because these findings could help promote personal resources such as resilience, thereby perhaps also contributing to the positive development and better states of health in adolescents. Resilient adolescents are more likely to enter adulthood with a greater ability to cope well with difficult circumstances.

Ethics approval and consent to participate

The study protocol was approved by the Castilla-La Mancha Community Board Ministry of Education, Culture, and Sports and by the respective parties at the participating education centers. After obtaining this approval, a letter was sent to all the guardians involved, explaining the objectives of the study, and requesting their collaboration to allow their children to participate.

Competing interests

The authors declare that they have no competing interests.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors.

Authors’ contributions

RFCH, MJS, and MGA are the principal researchers and contributed equally to conceiving the study design, conducting the statistical analysis, and editing the manuscript. MJD, MJR, and RMG contributed to drafting the manuscript. All authors read and approved the final manuscript. The manuscript has been translated by a native English speaker for ensuring correct grammatical English.

Acknowledgements

We would like to thank the entire educational community of Cuenca in this study.

Availability of data and materials

Not applicable.

Author details

¹University of Castilla-La Mancha, Faculty of Nursing, Cuenca, Castilla La Mancha, Spain

Frisén A. Measuring health-related quality of life in adolescence. Acta Paediatrica. 2007;96(7):963–8.
Feher PV, Annar D, Zsakai A, Bodzsar E. The association of psychosomatic health with physical status and lifestyle factors in adolescence. Anthropologischer Anzeiger. 2018;75(4):279–90.
Berntsson LT, Köehler L, Gustafsson JE. Psychosomatic complaints in schoolchildren: A Nordic comparison. Scandinavian Journal of Public Health. 2001;29(1):44–54.
Husain K, Browne T, Chalder T. A review of psychological models and interventions for medically unexplained somatic symptoms in children. Child and Adolescent Mental Health. 2007;12(1):2–7.
Van Geelen SM, Hagquist C. Are the time trends in adolescent psychosomatic problems related to functional impairment in daily life? A 23-year study among 20,000 15–16year olds in Sweden. Journal of Psychosomatic Research. 2016;(87):50–6.
Piko BF, Varga S, Mellor D. Are adolescents with high self-esteem protected from psychosomatic symptomatology? European Journal of Pediatrics. 2016;175(6):785–92.
Rieffe C, Villanueva L, Adrián JE, Górriz AB. Quejas somáticas, estados de ánimo y conciencia emocional en adolescentes. Psicothema. 2009;21(3):459–64.
Campo JV. Annual Research Review: Functional somatic symptoms and associated anxiety and depression - developmental psychopathology in pediatric practice. Journal of Child Psychology and Psychiatry. 2012;53(5):575–92.
Sánchez Mascaraque P, Guerrero Alzola F. Actualización del trastorno psicosomático en la infancia y adolescencia. Pediatr Integral. 2017;21(1):32–8.
Sánchez Mascaraque P, Barrio Rodriguez A. Trastornos psicosomáticos. Pediatria Integral. 2012;16(9):700–6.
Ibeziako P, Bujoreanu S. Approach to psychosomatic illness in adolescents. Current Opinion in Pediatrics. 2011;23(4):384–9.
Simpson K, Janssen I, Boyce WF, Pickett W. Risk taking and recurrent health symptoms in Canadian adolescents. Preventive Medicine. 2006;43(1):46–51.
Páramo MA. Factores de riesgo y factores de protección en la adolescencia: análisis de contenido a través de grupos de discusión. Terapia psicológica. 2011;29(1):85–95.
Vinaccia S, Quiceno JM, Moreno P. Resiliencia en adolescentes. Revista Colombiana de Psicología. 2007;16(0):139–46.
Gaxiola J, González S, Contreras Z, Gaxiola E. Predictores del rendimiento académico en adolescentes con disposiciones resilientes y no resilientes. Revista de Psicología. 2012;30(1):47–74.
Sánchez-Perales M, Álvarez-Aguirre A, Mendoza-Ayala MA, Hernández-Castañón A, Bañuelos-Barrera Y, Rocha-Rodríguez R. Resiliencia y consumo de drogas lícitas en adolescentes estudiantes de la ciudad de Morelia. Ciencia@Uaq. 2013;6(2):1–8.
Konaszewski K, Niesiobędzka M, Surzykiewicz J. Resilience and mental health among juveniles: role of strategies for coping with stress. Health and Quality of Life Outcomes. 2021 Feb 18;19(1):58.
Schneiderman N, Ironson G, Siegel SD. Stress and health: Psychological, behavioral, and biological determinants. Annual Review of Clinical Psychology. 2005;1(1):607–28.
Campbell-Sills L, Cohan SL, Stein MB. Relationship of resilience to personality, coping, and psychiatric symptoms in young adults. Behaviour Research and Therapy. 2006;44(4):585–99.
Hagquist C. Psychometric properties of the PsychoSomatic Problems scale: A Rasch analysis on adolescent data. Social Indicators Research. 2008;86(3):511–23.
Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depression and anxiety. 2003;18(2):76–82.
Serrano MD, Garrido M, Notario B, Bartolomé R, Solera M, Martínez V. Validez de la escala de resiliencia de Connor-Davidson (10 ítems) en una población de mayores no institucionalizados. Enfermeria Clinica. 2013;23(1):14–21.
Hagquist C. Discrepant trends in mental health complaints among younger and older adolescents in Sweden: an analysis of WHO Data 1985–2005. Journal of Adolescent Health. 2010;46(3):258–64.
Svedberg P, Eriksson M, Boman E. Associations between scores of psychosomatic health symptoms and health-related quality of life in children and adolescents. Health and quality of life outcomes. 2013;11:176.
Friberg P, Hagquist C, Osika W. Self-perceived psychosomatic health in Swedish children, adolescents and young adults: an internet-based survey over time. BMJ open. 2012;2(4).
Fuentes RM, Simón MJ, Garrido M, Serrano MD, Larrañaga ME, Yubero S. Síntomas psicosomáticos como expresión del deterioro de la calidad de vida relacionada con la salud en adolescentes. Atención Primaria. 2017;50(8):493–9.
Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. The Lancet. 2012;379(9820):1056–67.
Beck JE. A developmental perspective on functional somatic symptoms. J Pediatr Psychol. 2008;33(5):547–62.
Murberg TA, Bru E. School-related stress and psychosomatic symptoms among norwegian adolescents. School Psychology International. 2004;25(3):317–32.
Forrest CB, Bevans KB, Riley AW, Crespo R, Louis TA. Health and school outcomes during children’s transition into adolescence. Journal of Adolescent Health. 2013;52(2):186–94.
Sonmark K, Godeau E, Augustine L, Bygren M, Modin B. Individual and contextual expressions of school demands and their relation to psychosomatic health a comparative study of students in France and Sweden. Child Indicators Research. 2016;9(1):93–109.
García R, Pérez F, Pérez J, Natividad LA. Evaluación del estrés académico en estudiantes de nueva incorporación a la universidad. Academic stress in first-year college students. 2012;44(2):143–54.
Barra-Almagia E. Influencia del estrés y el ánimo depresivo sobre la salud adolescente: análisis concurrente y prospectivo. Universitas Psychologica. 2009;8(1):175–82.
Barra E. Influencia del estado emocional en la salud física. Ter. Psicol. 2003; 21(1): 55–60.
González M-T, Landero R. Síntomas psicosomáticos auto-informados y estrés en estudiantes de psicología. Revista de Psicología Social. 2006;21(2):141–52.
Rodríguez A, Ramos E, Ros I, Fernández A, Revuelta L. Resiliencia e implicación escolar en función del sexo y del nivel educativo en educación secundaria. Aula abierta. 2016;44(2):77–82.
Bonanno GA, Kennedy P, Galatzer-Levy IR, Lude P, Elfström ML. Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabilitation Psychology. 2012;57(3):236–47.
Smith MM, Saklofske DH, Keefer K v., Tremblay PF. Coping strategies and psychological outcomes: The moderating effects of personal resiliency. Journal of Psychology: Interdisciplinary and Applied. 2016;150(3):318–32.
Arrogante Ó. Mediación de la resiliencia entre burnout y salud en el personal de Enfermería. Enfermeria Clinica. 2014;24(5):283–9.
García MD, Siverio MÁ. Sadness in children, adolescents and adults: A comparative analysis. Infancia y Aprendizaje. 2005;28(4):453–69.
Klemanski DH, Curtiss J, McLaughlin KA, Nolen-Hoeksema S. Emotion regulation and the transdiagnostic role of repetitive negative thinking in adolescents with social anxiety and depression. Cognitive Therapy and Research. 2017;41(2):206–19.
Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years [DALYs] for 291 diseases and injuries in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012;380(9859):2197–223.
Kwek A, Bui HT, Rynne J, So KKF. The impacts of self-esteem and resilience on academic performance: An investigation of domestic and international hospitality and tourism undergraduate students. Journal of Hospitality and Tourism Education. 2013;25(3):110–22.

No competing interests reported.

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Psychosomatic Symptoms: Resilience as a Protective Factor in Adolescents. Observational, Descriptive, Cross-Sectional, and Multicenter Study

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References

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Status:

Version 1