نقش روان رنجوری و استرس های مربوط به مدرسه در درک علایم جسمانی در میان دانش آموزان در مدارس راهنمایی نروژی

The present study investigated the role of neuroticism and perceived school-related stress in somatic symptoms among a sample of 327 (167 females and 160 males) students in two Norwegian junior high schools. The results suggest that the role of neuroticism on somatic symptoms may be overestimated, and that the role of stress may be underestimated if neuroticism, stress and somatic symptoms are measured at the same time. In this study, both neuroticism and perceived school-related stress were found to be significantly associated with somatic symptoms.

Stress is common in the lives of adolescents and the general assumption is that frequent stress contributes to somatic symptoms1 among school-aged children (Greene & Walker, 1997; Poikolainen, Kanerva, & Lonnquist, 1995). Most studies on the psychological determinants of somatic symptoms among adolescents have adopted psychiatric and paediatric perspectives (Garralda, 1992) and have focused on the impact of major stressful life events on adolescent health and psychological well-being. Compared with major life events scores, hassles scores have been found to be better predictors of both psychological (Holahan, Holahan, & Belk, 1984; Wagner, Compas, & Howell, 1988) and somatic symptomatology (DeLongis, Coyne, Dakof, Folkman, & Lazarus, 1982; Zarski, 1984). There may therefore be a need for more non-clinical studies of the associations between the experience of daily stress and adjustment among adolescents. In the present study, we define stress in terms of the relationships between the person and his or her environment. Stress may occur when there are demands that are perceived by the person to tax or exceed his or her adaptive resources. Our focus is on adolescent perception and self-reports of stress. Adolescents spend a lot of time in school and this arena can pose social and academic challenges. Spirito, Stark, Grace, and Stamoulis (1991) note that when young adolescents are asked to name the most upsetting events during the last month, school incidents are consistently among the three most common problems mentioned. School-related psychosocial stress may include interpersonal problems, such as conflicts with friends and/or other students, and teachers, as well as schoolwork pressure and fear of failing in schoolwork. In addition, strained relations with parents could be related to conflicts concerning effort and/or achievement at school. Finally, the transition from primary school to secondary school may be a stressful experience for many students. Boekaerts, Seegers, and Van den Goor (1993) reported that students who display stress symptoms during the transition from primary school to secondary school emphasized that they felt uncertain and unhappy due to stressors such as complex timetables, long hours, complex grading systems, and quantity of homework. These school-related stressors may, in turn, have a negative impact on students’ health. In a recent Norwegian study among adolescents, school-related stress was linked to elevated somatic health symptoms (Torsheim & Wold, 2001). Even though evidence suggests that adolescents with high levels of stress are at increased risk of somatic symptoms, findings indicate that this relationship is weak (see Compas, Orosan, & Grant, 1993). These findings together with observations of individual differences in responses to stressors have stimulated a search for other factors that may influence the stress–health relationship among adolescents. In order to understand this association, researchers have turned to personality differences that may render some adolescents more or less immune to stress-induced somatic symptoms and others relatively susceptible. One variable that has received attention as a potential moderator is individual differences in the personality trait of neuroticism. Neuroticism is a broad and pervasive dimension of normal personality that includes a tendency to experience negative emotions and to be highly self-conscious and somatically worried (Costa & McCrae (1985) and Costa & McCrae (1987)). Amplification of somatic symptoms is a common feature of neuroticism, but the relationship with objective pathology is rather weak. Previous research in somatization has identified strong positive relationships between neuroticism and somatic symptoms (see Costa & McCrae, 1987; Dickson et al., 1992; Lu, 1994; Watson & Pennebaker, 1989). An exception is the study by Brown and Moskowitz (1997), where neuroticism was found to be unrelated to reports of physical symptoms. Although neuroticism is considered to be an important predictor of somatic symptoms, perceptions of stress appear to be influenced by the level of neuroticism when they are obtained at the same time. Several studies where measures of neuroticism and measures of stress are obtained at the same time have indicated an association between these variables (De Jong, van Sonderen, & Emmelkamp, 1999; Lu, 1994; Schroeder & Costa, 1984; Watson, 1988). However, methodological features that create interpretive difficulties characterize several of these studies. The use of a cross-sectional design where the predictor and criterion variables are obtained at the same time makes it difficult to establish causal inferences. Such inferences are more easily made using prospective designs, in which the predictor variables are obtained before the outcomes measure, and then predictive relationships are measured. Thus, there is a need for prospective studies that provide a more valid assessment of the relationships between personality and somatic symptoms. The pervasive role of neuroticism in relation to stress and reported somatic symptoms has led some personality researchers to suggest that the associations between stress and somatic symptoms may occur because of the operation of neuroticism, and that this association may be spurious as a result of the pervasive role of neuroticism on both stress and somatic symptoms (see McCrae, 1990; Watson & Pennebaker, 1989). These personality theoreticians have therefore suggested that the association between stress and somatic symptoms is overestimated because self-reported measures of stress and health are both contaminated by measures of neuroticism. We suggest that this explanation is not unequivocal. In cross-sectional design, measures of neuroticism may be inflated by measures of stress as well as somatic symptoms. There is evidence to suggest that scales for measuring neuroticism are similar in form and content to scales for measuring somatic symptoms and negative affective states (Ormel, 1983). There is also evidence that measures of neuroticism are contaminated by mental health states at the time of measurement (see Ingham, Kreitman, McMiller, Sashidharan, & Surtees, 1986; Ormel & Wohlfarth, 1991). Consequently, the measure of the personality trait of neuroticism may not only measure the individual's trait, but also perceived school-related stress and somatic symptoms. To what extent the trait of neuroticism and the individual's present state explain the variance in somatic symptoms is therefore ambiguous. Our suggestion is that the role of neuroticism on somatic illness may be exaggerated, just as the role of stress may be underestimated if these variables are measured at the same time, because measures of neuroticism may be confounded by measures of stress and measures of symptomatology. The major aim of this study is therefore to explore the role of neuroticism and perceived school-related stress in somatic symptoms among a sample of adolescents.