Rayce Signe L B, Holstein Bjørn E, Kreiner Svend
Department of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
Eur J Public Health. 2009 Jan;19(1):79-84. doi: 10.1093/eurpub/ckn105. Epub 2008 Nov 11.
The purpose was to examine the association between aspects of alienation and symptom load among adolescents. Furthermore an integrated purpose was to construct and validate an index of alienation.
Cross-sectional data from 5205 school children aged 11-15 years from a random sample of schools in Denmark were used. Data stems from the Danish contribution to the cross-national study Health and Behaviour in School-aged Children (HBSC). Alienation was measured with a new index fulfilling four criteria: (i) theoretical foundation, (ii) inter-correlation between items, (iii) correlation between each of the index's items and the outcomes and (iv) no differential item functioning. The final index included three indicators of alienation: helplessness, feeling left out of things and lack of confidentiality with parents. Symptom load was measured by HBSC Symptom Checklist and divided into physical and psychological symptoms respectively. High symptom load was defined as experiencing at least one symptom on a daily basis.
The odds-ratio (OR) for high symptom load increased with the degree of alienation. For students with all three indicators of alienation, the OR for high physical symptom load was 2.49 (1.05-5.87). The OR for high psychological symptom load for the corresponding degree of alienation was 6.50 (3.11-13.56).
The index of alienation fulfilled psychometric criteria for scalability. Furthermore the analyses showed a graded and significant association between alienation and high symptom load. This suggests alienation to be taken into account in future health interventions among adolescents. In school settings this may be done using principles of empowerment.
目的是研究青少年疏离感各方面与症状负荷之间的关联。此外，一个综合目的是构建并验证一个疏离感指数。
使用了来自丹麦随机抽取的学校中5205名11至15岁学童的横断面数据。数据源自丹麦对跨国研究“学龄儿童健康与行为”（HBSC）的贡献。使用一个满足四项标准的新指数来衡量疏离感：（i）理论基础，（ii）各项目之间的相互关联，（iii）指数中每个项目与结果之间的关联，以及（iv）无项目功能差异。最终指数包括疏离感的三个指标：无助感、被排除在外的感觉以及与父母缺乏信任感。症状负荷通过HBSC症状清单进行测量，并分别分为身体症状和心理症状。高症状负荷被定义为每天至少经历一种症状。
高症状负荷的优势比（OR）随着疏离感程度的增加而升高。对于具有所有三个疏离感指标的学生，高身体症状负荷的OR为2.49（1.05 - 5.87）。相应疏离感程度下高心理症状负荷的OR为6.50（3.11 - 13.56）。
疏离感指数满足可扩展性的心理测量标准。此外，分析显示疏离感与高症状负荷之间存在分级且显著的关联。这表明在未来青少年健康干预中应考虑疏离感。在学校环境中，可以采用赋权原则来做到这一点。
