Differences between countries in how social inequalities in adolescents’ mental health have evolved over the long term are not yet clearly understood. The influence of wider societal shifts on these patterns is similarly unclear. We investigated three key issues: (1) whether the relationship between family socioeconomic status and both psychological and somatic complaints altered between 2002 and 2022, (2) the degree to which any such changes differed from one country to another, and (3) whether within-country shifts in income inequality, perceived schoolwork pressure, and internet activity helped explain these trends. The analysis drew on data from 903,344 adolescents across 32 countries who participated in the Health Behavior in School-aged Children (HBSC) survey waves conducted between 2002 and 2022. Multilevel modeling was used to examine the research questions.
Psychological and somatic complaints showed a nonlinear upward trend across the study period. Overall, the size of social inequalities in both types of complaints remained fairly constant across the full set of countries, yet the specific trajectories varied markedly between nations. Among the societal factors examined, only rising income inequality accounted for differences in these trends across countries. In nations where income inequality grew during the period, the gap in psychological complaints between socioeconomic groups actually became smaller. The findings underline the continued existence of substantial global differences in adolescents’ mental health difficulties and emphasize the need for stronger, more targeted health policies.
