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h ps://idus.us.es/
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online a : h ps://doi.o g/10.1007/s12187-017-9489-0
Child Indica o s Resea ch
Mul idimensional dep i a ion among adolescen s in 39 coun ies: e idence om he
Heal h Beha iou in School-Aged Child en (HBSC) 2013/14 s udy
--Manusc ip D a --
Manusc ip Numbe : ISCI-D-16-00082
Full Ti le: Mul idimensional dep i a ion among adolescen s in 39 coun ies: e idence om he
Heal h Beha iou in School-Aged Child en (HBSC) 2013/14 s udy
A icle Type: O iginal esea ch
Keywo ds: mul idimensional dep i a ion; adolescen well-being; Heal h Beha iou in School-aged
Child en S udy; Sus ainable De elopmen Goals
Co esponding Au ho : Zla a B uckau
UNICEF O ice o Resea ch-Innocen i
ITALY
Co esponding Au ho Seconda y
In o ma ion:
Co esponding Au ho 's Ins i u ion: UNICEF O ice o Resea ch-Innocen i
Co esponding Au ho 's Seconda y
Ins i u ion:
Fi s Au ho : Yeka e ina Chzhen
Fi s Au ho Seconda y In o ma ion:
O de o Au ho s: Yeka e ina Chzhen
Zla a B uckau
Emilia Toczydlowska
F ank Elga
Concepción Mo eno-Maldonado
Gonneke S e ens
Dagma Sigmundo á
Gene iè e Ga iépy
O de o Au ho s Seconda y In o ma ion:
Funding In o ma ion: Agencia de Inno ación y Desa ollo de
Andalucía
(SEJ 08007)
MSc Concepción Mo eno-Maldonado
Abs ac : This s udy in es iga ed he applica ion o UNICEF's Mul iple O e lapping Dep i a ion
Analysis (MODA) amewo k o 40 Eu opean egions and Canada using da a on
adolescen s aged 11, 13 and 15 om he 2013/14 Heal h Beha iou in School-aged
Child en su ey. I is he i s applica ion o MODA ha is based en i ely on da a
collec ed om adolescen s hemsel es a he han om household e e ence pe sons
on hei behal . Unlike o he MODA s udies, he p esen analysis mos ly ocuses on
non-ma e ial, ela ional aspec s o child dep i a ion. Al hough he e is subs an ial
c oss-coun y a ia ion in he p e alence o adolescen dep i a ions ega ding nu i ion,
pe cei ed heal h, school en i onmen , p o ec ion om pee iolence, amily
en i onmen and in o ma ion access, ou indings unde line ha hese mo e subjec i e
single dimensions o dep i a ion ha dly a y wi h na ional weal h and income inequali y
Howe e , when ocusing on dep i a ion on a leas h ee dimensions (i.e.,
mul idimensional dep i a ion), esul s showed ha wi h inc easing na ional le el
income inequali y, sha es o adolescen s dep i ed in h ee o mo e ou o six
dimensions also inc eased. In he majo i y o coun ies. gi ls we e a a highe isk o
mul idimensional dep i a ion han boys. In addi ion, adolescen s no li ing wi h bo h
pa en s in he household and hose epo ing lowe le els o amily weal h we e
Powe ed by Edi o ial Manage ® and P oduXion Manage ® om A ies Sys ems Co po a ion
consis en ly mo e dep i ed han o he adolescen s, bo h ega ding single and
mul idimensional dep i a ion. The esul s o his s udy show he in e connec edness o
social ( amily, school suppo ) and psychological (heal h and iolence) dep i a ions o
adolescen s h oughou Eu ope, e.g. child en dep i ed in he domain o amily and
school en i onmen a e likely o be also dep i ed in he pe cei ed heal h and
p o ec ion om pee iolence.
Powe ed by Edi o ial Manage ® and P oduXion Manage ® om A ies Sys ems Co po a ion
Mul idimensional dep i a ion among adolescen s in 39 coun ies: e idence om he
Heal h Beha iou in School-Aged Child en (HBSC) 2013/14 s udy
Chzhen, Y1., B uckau , Z.1, Toczydlowska, E.1, Elga , F.2, Mo eno-Maldonado, C.3,
S e ens, GW.J.M..4, Sigmundo á, D.5 and Ga iépy, G.6
1 UNICEF O ice o Resea ch-Innocen i, Piazza SS Annunzia a, 12, 50122 Flo ence, I aly
2 Ins i u e o Heal h and Social Policy and Douglas Ins i u e, McGill Uni e si y, 1130 Pine
A enue Wes , Mon eal, QC H3A 1A3, Canada
3 Depa men o De elopmen al and Educa ional Psychology, Uni e si y o Se ille,
C/ Camilo José Cela, s/n, 41018 Se ille, Spain
4 U ech Cen e o Child and Adolescen S udies, U ech Uni e si y, P.O. Box 80140, 3508
TC U ech , The Ne he lands
5Facul y o Physical Cul u e, Palacký Uni e si y Olomouc, Tř. Mí u 117, 77111 Olomouc,
Czech Republic
6 Ins i u e o Heal h and Social Policy | McGill Uni e si y, 1130 Pine A e Wes , Mon eal,
QC, H3A 1A3
Co esponding Au ho : Zla a B uckau . E-mail add ess: zb uckau @unice .o g.
Tel: (+39) 055 20 330 Fax: (+39) 055 2033 220
Acknowledgemen s: The Heal h Beha iou in School-aged Child en (HBSC) s udy is a
Wo ld Heal h O ganiza ion collabo a i e s udy and is suppo ed by each membe coun y o
he HBSC ne wo k (www.hbsc.o g). The HBSC s udy is coo dina ed in e na ionally by D
Joanna Inchley, Uni e si y o S . And ews, Sco land, wi h in e na ional da a coo dina ion
pe o med by D Odd un Samdal, Uni e si y o Be gen, No way.
Ti le Page
1
Mul idimensional dep i a ion among adolescen s in 39 coun ies: e idence om he
Heal h Beha iou in School-Aged Child en (HBSC) 2013/14 s udy
Abs ac
This s udy in es iga ed he applica ion o UNICEF’s Mul iple O e lapping Dep i a ion
Analysis (MODA) amewo k o 40 Eu opean egions and Canada using da a on adolescen s
aged 11, 13 and 15 om he 2013/14 Heal h Beha iou in School-aged Child en su ey. I is
he i s applica ion o MODA ha is based en i ely on da a collec ed om adolescen s
hemsel es a he han om household e e ence pe sons on hei behal . Unlike o he MODA
s udies, he p esen analysis mos ly ocuses on non-ma e ial, ela ional aspec s o child
dep i a ion. Al hough he e is subs an ial c oss-coun y a ia ion in he p e alence o
adolescen dep i a ions ega ding nu i ion, pe cei ed heal h, school en i onmen , p o ec ion
om pee iolence, amily en i onmen and in o ma ion access, ou indings unde line ha
hese mo e subjec i e single dimensions o dep i a ion ha dly a y wi h na ional weal h and
income inequali y. Howe e , when ocusing on dep i a ion on a leas h ee dimensions (i.e.,
mul idimensional dep i a ion), esul s showed ha wi h inc easing na ional le el income
inequali y, sha es o adolescen s dep i ed in h ee o mo e ou o six dimensions also inc eased.
In he majo i y o coun ies, gi ls we e a a highe isk o mul idimensional dep i a ion han
boys. In addi ion, adolescen s no li ing wi h bo h pa en s in he household and hose epo ing
lowe le els o amily weal h we e consis en ly mo e dep i ed han o he adolescen s, bo h
ega ding single and mul idimensional dep i a ion. The esul s o his s udy show he
in e connec edness o social ( amily, school suppo ) and psychological (heal h and iolence)
dep i a ions o adolescen s h oughou Eu ope. Child en dep i ed in he domain o amily and
school en i onmen a e also likely o be dep i ed in he pe cei ed heal h and p o ec ion om
pee iolence.
Key wo ds: mul idimensional dep i a ion; adolescen well-being; Heal h Beha iou in School-
Aged Child en S udy; Sus ainable De elopmen Goals.
Blinded Manusc ip Click he e o iew linked Re e ences
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1. In oduc ion
I has been widely acknowledged ha child en ha e basic human igh s, such as a su icien
supply o heal hy oods, access o heal h ca e, access o educa ion, and eedom o g ow up in
a sa e en i onmen . These igh s a e undamen al o child wellbeing and ensh ined in he
Uni ed Na ions’ 1989 Con en ion on he Righ s o he Child (CRC). UNICEF has de eloped
he Mul iple O e lapping Dep i a ion Analysis (MODA) o acili a e esea ch and su eillance
o child en and adolescen s who a e dep i ed o hese igh s. Like UNICEF’s Global S udy on
Child Po e y and Dispa i ies (Go don e al. 2003; UNICEF 2007), MODA uses child- ele an
indica o s o measu e dep i a ions in dimensions oo ed in he CRC bu wi h a g ea e emphasis
on o e lapping dimensions and age-app op ia e cons uc s o child en and you h (see de
Neubou g e al. 2012).
The aim o his s udy was o apply he MODA oolki o pu o wa d a new measu e o
mul idimensional dep i a ion among adolescen s in high- and middle-income coun ies in
Eu ope and Canada using da a om he WHO Heal h Beha iou in School-aged Child en
(HBSC) s udy 2013/14. This s udy sough o con ibu e o he li e a u e on mul idimensional
child dep i a ion and o illus a e how da a ha we e collec ed di ec ly om adolescen s could
be used o assess p og ess owa ds he new uni e sal Sus ainable De elopmen Goals.1 I is he
i s s udy o mul idimensional child dep i a ion ha is based en i ely on da a collec ed om
child en hemsel es a he han om household e e ence pe sons on behal o child en (e.g.
Chzhen e al. 2016a; Chzhen and Fe one 2016; de Milliano and Handa 2014; de Milliano and
Pla go 2014). Unlike p e ious MODA s udies, he p esen analysis mos ly ocused on non-
ma e ial, ela ional aspec s o child dep i a ion.
Resea ch ques ions and hypo heses
Child po e y is con en ionally measu ed in mone a y e ms, as a sha e o child en li ing in
households wi h income o consump ion below a ce ain po e y line. Howe e , his app oach
assumes ha child en ecei e a ai po ion o household esou ces and can con ol hei sha e
o amily esou ces, including social, educa ional, and cul u al capi al (Chzhen and Fe one
2016). Di ec measu es o child dep i a ion ha e been ound o complemen household-based
mone a y indica o s o dep i a ion (de Neubou g e al. 2014; Guio e al. 2012; Main and
B adshaw 2012). While ce ain household-le el dep i a ions (e.g. housing condi ions) a ec
1 SDG Ta ge 1.2 calls o “ educing a leas by hal he p opo ion o men, women and child en o all ages
li ing in po e y in all i s dimensions acco ding o na ional de ini ions” by 2030. See
h ps://sus ainablede elopmen .un.o g/sdg1.
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child en and you h (Chzhen e al. 2016a; Guio e al. 2012), i is use ul o collec a leas some
in o ma ion om child en hemsel es. Sel - epo s a e especially use ul o measu ing
child en’s exposu e o iolence ou side he home, school expe iences, and access o
in o ma ion.
Un il now, he consequences o dep i a ion o adolescen s a e discussed less han o
o he age g oups (Vine e al. 2012). This may be an impo an omission in he li e a u e, as
adolescence is a o ma i e li e s age in which disad an ages ha e las ing impac s on he li e
cou se (Alemán-Díaz e al. 2016; B ene e al. 2013; Hanson and Chen 2007; Woodwa d e al.
2003; Dmi ie a 2013). Al hough high-income Wes e n Eu opean wel a e s a es ha e achie ed
an unp eceden ed le el o ma e ial weal h, s udying adolescen dep i a ion in hese con ex s is
s ill c ucial (Mackenbach 2012). Social and economic changes in hese s a es ha e inc eased
he isk o poo heal h – no jus o economically disad an aged amilies bu o mo e middle-
class amilies and amilies wi h young child en as well (Li e al. 2008). In s udying adolescen
dep i a ion, he use o mul idimensional domains may be o i al impo ance as di e en
expe iences end o co-exis (E ans and Kim 2010). Fo ins ance, a ecen s udy o adolescen s
based on HBSC da a ound ha a clus e o isk beha io s (smoking, d inking, igh ing,
physical inju ies, and bullying o he s) ela ed o psychosoma ic symp oms and consump ion o
suga y d inks and swee s (Walsh e al. 2016).
The HBSC s udy collec s heal h in o ma ion om adolescen s aged 11, 13 and 15 yea s
ac oss mo e han 40 coun ies in Eu ope and No h Ame ica.2 The HBSC does no collec
in o ma ion on household income and al hough i collec s some socio-economic in o ma ion
such as pa en al occupa ion o educa ion, hese da a a e o en subjec o inaccu a e o missing
esponses (Ridol o and Mai land 2011; Rich e e al. 2012). Howe e , in addi ion o
in o ma ion on common ma e ial asse s in he home (e.g. ca s, compu e s), he HBSC su ey
collec s a weal h o in o ma ion on non-ma e ial aspec s o child well-being, such as heal h,
isk beha iou s, pee and amily ela ionships, and pee iolence (Cu ie e al. 2014).
Le e aging hese ich da a in a c oss-coun y compa a i e con ex , he speci ic objec i es o
his s udy we e o: (1) examine c oss-na ional di e ences in he p opo ion o mul idimensional
adolescen dep i a ion in 39 coun ies (and 41 egions) ha pa icipa ed in he 2013/14 HBSC
s udy,3 including associa ions be ween dep i a ion a es, egion weal h and income inequali y;
(2) analyze di e ences in mul iple dep i a ion owing o indi idual cha ac e is ics such as age,
2 See www.hbsc.o g.
3 We excluded G eenland om he analysis.
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gende , amily s uc u e and pe cei ed amily weal h; and (3) iden i y g oups o child en in
mul iple dimensions o dep i a ion and cons ella ions o mul iple dep i a ions ha end o co-
occu .
P e ious c oss-na ional s udies ha e ound ha he mos obus s uc u al de e minan s
o adolescen heal h and wellbeing a e na ional weal h (i.e. na ional GDP pe capi a) and
income inequali y (Vine e al. 2012; Elga e al. 2015a; Elga e al. 2015b). Based on his
e idence and o he indings om MODA analyses in low and middle income coun ies (de
Milliano and Pla go 2014), we expec ed o ind ha low coun y weal h and high inequali y
bo h ela e o mo e dep i a ion in adolescen s in single and in mul iple dimensions. Based on
known social inequali ies in adolescen heal h be ween gende g oups and le els o
socioeconomic posi ion (Inchley e al. 2016), we expec ed o ind mo e dep i a ion in emales
han in males and in lowe socioeconomic g oups (pa icula ly in he heal h dimension).
Fu he mo e, gi en he obus con ibu ion o amily and pee suppo on adolescen heal h and
wellbeing (Inchley e al. 2016), we expec ed o ind he highes deg ees o dep i a ion o e lap
among he dimensions oo ed in heal h and amily and pee ela ionships.
2. Da a and me hods
The 2013/14 HBSC s udy ec ui ed nea ly 220,000 adolescen s aged 11, 13 and 15 yea s ac oss
39 coun ies (42 egional uni s). We had sub-na ional in o ma ion o wo coun ies: Belgium
(Flande s and Wallonia) and G ea B i ain (England, Sco land and Wales). We e e o all
coun ies and sub-na ional uni s as egions in he emainde o his pape . S a i ied samples o
schools ha ep esen he egional, economic, and public-p i a e dis ibu ion o schools in each
egional uni we e ec ui ed using a common p o ocol (Inchley e al. 2016). Schools we e
sampled wi h eplacemen as needed wi hin each s a um o ensu e consis en sample
composi ion be ween coun ies. The HBSC p o ocol s ipula ed a s anda d ques ionnai e o ma ,
i em o de , and es ing condi ions. Teache s o ained in e iewe s dis ibu ed he
ques ionnai es in class oom se ings. Each membe coun y ob ained e hics clea ance o
conduc he su ey om a uni e si y-based e iew boa d o equi alen egula o y body. You h
in p i a e and special needs schools and s ee and inca ce a ed you h we e excluded.
2.1.Indica o s and dimensions
The HBSC ques ionnai e ocuses on heal h ou comes, well-being, heal h- ela ed beha iou s
and social en i onmen s (Inchley e al. 2016). The da a a e sui ed o he s udy o adolescen
mul idimensional dep i a ion using UNICEF’s MODA amewo k because hey co e many
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o he child igh s dimensions embedded in he CRC (Uni ed Na ions 1989) “ ha a e essen ial
o any child’s de elopmen i espec i e o hei coun y o esidence, socio-economic s a us,
o cul u e” (de Neubou g e al. 2012, pp.14-15). The CRC has been a i ied by all coun ies
excep he Uni ed S a es. We iden i ied six dimensions in he HBSC da a: nu i ion, pe cei ed
heal h, school en i onmen , p o ec ion om pee iolence, amily en i onmen , and access o
in o ma ion.
Table 1 classi ies HBSC a iables in o indica o s and dimensions o child dep i a ion.
Each o he six dimensions is ep esen ed by wo indica o s. The ole o hese indica o s is o
ope a ionalize he igh s-based dimensions using he bes da a a ailable (Chzhen e al. 2016a).
Fo ins ance, gi ing all adolescen s compu e s would no necessa ily e adica e he unde lying
dep i a ion in in o ma ion access, bu no ha ing a compu e a home sugges s lowe access o
in o ma ion. Indica o s a e agg ega ed in o dimensions using he union app oach: i a child is
dep i ed on jus one indica o ou o he wo, hey a e coun ed as dep i ed in he espec i e
dimension. Al hough his esul s in a highe dep i a ion headcoun han i dep i a ion in bo h
indica o s we e equi ed (i.e., he in e sec ion app oach), he union app oach is mo e consis en
wi h he child igh s amewo k: he absence o dep i a ion in one indica o does no make up
o dep i a ion in ano he .
Table 1 Child dep i a ion indica o s, dimensions and h esholds
Dimension Indica o Indica o h eshold: de
p
i ed i
Nu i ion B eak as on weekda
y
s Ne e ea s b eak as on weekda
y
s.
Consump ion o ui s and
e
g
e ables
Consumes ui s o ege ables less
han once a week.
Pe cei ed heal h Sel - a ed heal h Fai o
p
oo sel - a ed heal h.
Heal h complain s Repo s wo o mo e ou o eigh
heal h s
y
m
p
oms e e
y
da
y
.
School en i onmen S uden suppo
No classma e suppo . Disag ees o
s ongly disag ees wi h a leas one
o he ollowing s a emen s: “ he
s uden s in my class enjoy being
oge he ”, “mos o he s uden s in
my class a e kind and help ul” and
“o he s uden s acce
p
me as I am”.
Teache suppo No eache suppo . Disag ees o
s ongly disag ees wi h a leas one
o he ollowing s a emen s: “I eel
ha my eache s accep me as I am”,
“I eel ha my eache s ca e abou
me as a pe son” and “I eel a lo o
us in m
y
eache s”.
P o ec ion om pee
iolence
Bullied Being bullied a school a leas once
in he pas couple o mon hs.
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widesp ead o consis en as in heal h dep i a ion. Gi ls we e mo e likely o be dep i ed in
classma e o eache suppo in se en egions ou o 41, wi h he la ges di e ences o 6 and 7
poin s in Li huania and Es onia, espec i ely. In con as , boys we e a a g ea e isk in
Ge many (4 poin s), Is ael (3 poin s) and Slo enia (3 poin s).
Figu e 4 anks egions by he a e o dep i a ion in p o ec ion om pee iolence,
anging om a low o 15% in A menia o a high o 61% in Li huania. Jus o e hal o
adolescen s (51%) we e dep i ed in his dimension in Wallonia (Belgium), Russia, La ia and
Li huania. Again, p e alence a es did no a y signi ican ly wi h mac o-economic ac o s.
Ac oss he wo indica o s, he a es o dep i a ion we e highe o bullying han o cybe -
bullying. Boys we e mo e likely o epo he o me , while gi ls we e mo e likely o epo he
la e . Boys we e mo e likely o be dep i ed in he o e all iolence dimension in 13 egions
ou o 41, wi h he la ges di e ence o 16 poin s in Is ael, while gi ls we e a a g ea e isk in
nine egions, wi h he la ges gaps o 7-10 poin s ound in Canada, Wales, England, Sco land
and I eland.
Incidence o dep i a ion in amily en i onmen anged om 16-17% in Sweden,
Finland, No way and Denma k o 41-45% in Russia and Bulga ia (Figu e 5), bu he e we e no
signi ican associa ions wi h mac o-economic indica o s. A he lowe end o he dep i a ion
anking, poo e egions like Li huania and Uk aine had one in i e adolescen s dep i ed in his
dimension, compa ed wi h a leas one in h ee in iche egions like I eland, Iceland and F ance
a he highe end o he anking. Gende di e ences wi hin egions we e mixed: gi ls we e
mo e likely o be dep i ed in nine egions (wi h he la ges gap o 7 poin s in Flande s) and
boys in ano he eigh (wi h he la ges gap o 6 poin s in Moldo a).
Figu e 6 demons a es ha dep i a ion p opo ion in in o ma ion access was gene ally
lowe han in o he dimensions, anging om one in wen y adolescen s in he Ne he lands,
Wales, Sco land and Finland o a ound one in i e (21-23%) in A menia and Moldo a and o e
one in h ee (35%) in Albania. In con as o he o he dimensions, dep i a ion in in o ma ion
access a ied signi ican ly wi h economic de elopmen (GDP pe capi a; =-0.46; p<0.01) and
income inequali y (Gini coe icien ; =0.41; p<0.05).9 Ac oss he wo indica o s, p opo ions
o adolescen s wi h no compu e a home we e below 10% (excep in Albania, A menia and
Moldo a), which was consis en ly lowe han he sha e o adolescen s who did no use
compu e s on weekdays. Boys and gi ls we e as likely o ha e a compu e a home (excep in
9 The e ec o income inequali y appea s o be spu ious because when he in o ma ion dep i a ion a e is eg essed
on bo h GDP pe capi a (PPP) and he Gini coe icien , he e ec o he la e is no longe signi ican .
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Albania whe e gi ls we e mo e dep i ed on his indica o ), bu boys we e mo e likely o no
use compu e s on weekdays (excep in Albania and A menia). This p oduced signi ican ly
highe dep i a ion a es in in o ma ion access among boys in 18 egions, wi h he la ges
gende gap o 5 poin s in Bulga ia. Meanwhile, he dep i a ion a e was 3 poin s and 11 poin s
highe o gi ls in A menia and Albania, espec i ely.
Ac oss all six dimensions, adolescen s no li ing wi h bo h pa en s in he household
and hose epo ing lowe le els o amily weal h we e consis en ly mo e dep i ed. Olde
adolescen s we e mo e likely o be dep i ed in each dimension excep iolence10 and
in o ma ion access. Ne gende e ec s in dep i a ion a es emained e en when adjus ed o
age, amily s uc u e and amily weal h, since hese cha ac e is ics we e dis ibu ed equally
ac oss boys and gi ls. In he wo coun ies o which we had sub-na ional in o ma ion,
di e ences be ween egions we e some imes s a k. Adolescen s in Wallonia we e subs an ially
mo e likely o be dep i ed han hei Flemish coun e pa s in e e y dimension excep amily
en i onmen and in o ma ion access. Dep i a ion a es we e lowe in England han in Sco land
and Wales in nu i ion, heal h and school en i onmen .
3.2.Mul idimensional dep i a ion
The six dimensions o dep i a ion ended o o e lap in his s udy so ha e en in egions wi h
lowe dep i a ion a es in single dimensions, a leas one in wo adolescen s we e dep i ed in
one o mo e dimensions. This p opo ion anged om he low o 54% in Sweden o he high
o 87% in Russia and Wallonia. D awing he cu -o a wo o mo e dimensions ou o six
p oduced dep i a ion a es anging om 24% in Sweden o 61% in Bulga ia and Wallonia. In
he emainde o hese analyses, we used he cu -o o h ee dimensions because i p oduced
less ex eme headcoun a es han he cu -o o wo o mo e, while s ill main aining a high
deg ee o a ia ion ac oss egions. Highe cu -o s (i.e. ou o mo e; i e o mo e) p oduced
subs an ially lowe dep i a ion a es, wi h li le a ia ion ac oss egions, sugges ing ha mos
di e ences lied in he sha es o adolescen s dep i ed in wo o h ee dimensions
simul aneously. The choice o one cu -o o illus a i e pu poses is somewha a bi a y, bu
due o space limi a ions we could no show he esul s o all possible cu -o s. Ou obus ness
10 Olde adolescen s we e consis en ly less likely o be bullied, bu in se e al coun ies hey we e a a highe isk
o cybe bullying by pic u es o messages. Since he a es o cybe bullying end o be lowe , olde adolescen s
appea ed o be less likely o be dep i ed in he p o ec ion om iolence dimension (es ima es a ailable on
eques ).
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checks show simila esul s when using wo o h ee ou o six dimensions as he cu -o
(es ima es a ailable on eques ).
Figu e 7 anks egions by he sha e o adolescen s dep i ed in a leas h ee ou o six
dimensions. Ra es anged om one in en (9-10%) in No way and Sweden o abou one in h ee
in Bulga ia, La ia, Russia and Wallonia (32-34%). Weal hie na ions ended o ha e lowe
a es o mul idimensional dep i a ion ( =-0.31; p<0.10), bu his ela ionship appea s o ha e
been d i en by income inequali y. Mo e income unequal coun ies had highe sha es o
adolescen s dep i ed in h ee o mo e dimensions (Figu e 8), while iche egions ended o be
mo e equal. I he mul idimensional dep i a ion a e was eg essed on bo h egion weal h and
income inequali y hen he associa ion o egion weal h was no longe signi ican , while he
e ec o income inequali y held.
Gi ls we e mo e likely o be dep i ed in h ee o mo e dimensions han boys in 25 o
41 egions, wi h he la ges di e ence o 8 poin s in England. Boys we e mo e likely o be
dep i ed han gi ls in Is ael (5 poin s). Olde child en we e mo e likely o be dep i ed in h ee
o mo e dimensions in 21 egions, bu less likely o be dep i ed in ano he wo (Es onia and
Uk aine). Child en li ing wi h one o no pa en and hose epo ing low amily weal h we e
consis en ly mo e likely o be dep i ed in he majo i y o coun ies. The la ges di e ences by
amily s uc u e we e ound in Canada (14 poin s) and I eland (16 poin s), while Es onia
showed he g ea es ne e ec o pe cei ed amily weal h (35 poin s).
3.3.O e lap be ween dimensions
To in es iga e which dimensions mainly d o e mul idimensional dep i a ion among he HBSC
egions, we calcula ed he p opo ion o adolescen s dep i ed in h ee dimensions a a ime o
each o he 20 unique combina ions o six dimensions. The h ee mos equen combina ions
o h ee simul aneous dep i a ions we e: heal h, school en i onmen , and amily en i onmen ;
heal h, school en i onmen , and p o ec ion om pee iolence; and school en i onmen , amily
en i onmen , and p o ec ion om pee iolence. Each combina ion comp ised a ound 6% o
adolescen s in he o e all sample.
I is no able ha he same ou dimensions we e in ol ed in he op h ee combina ions.
In ac , 3% o adolescen s on a e age ac oss egions we e dep i ed in all ou simul aneously.
Figu e 9 shows he sha e o adolescen s dep i ed in heal h, school en i onmen , amily
en i onmen and p o ec ion om pee iolence a once, sepa a ely by egion. Ra es anged
om 1% in Albania, Sweden, Albania and No way o 6% in La ia, Russia, Wallonia and
Wales. Gi ls we e mo e likely o be dep i ed in all ou dimensions a once in he majo i y o
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he egions (29 o 41), wi h he la ges di e ence o six poin s in Wales. Boys we e mo e likely
o be dep i ed in all ou dimensions in Is ael (by 1.5 poin s). Con olling o gende , amily
s uc u e and pe cei ed amily weal h, olde adolescen s we e mo e likely o be dep i ed in
hese ou dimensions in jus unde one-hal o he egions (16 o 41). In 26 o 41 egions,
adolescen s om non- wo-pa en amilies we e signi ican ly mo e likely o be dep i ed in all
ou dimensions. Adolescen s who epo ed ha hei amily was no e y/no a all well o
we e mo e likely o be dep i ed in hese ou dimensions simul aneously in all bu wo egions
(Albania and A menia), wi h he la ges di e ence o 15 poin s ound in Es onia and La ia.
4. Discussion and conclusion
This s udy demons a ed he applica ion o he MODA amewo k o 40 Eu opean egions and
Canada using da a on adolescen s aged 11, 13 and 15 om he HBSC s udy. I is he i s
applica ion o MODA ha is based en i ely on da a collec ed om adolescen s hemsel es
a he han om household e e ence pe sons on behal o adolescen s (e.g. de Milliano and
Handa 2014; de Milliano and Pla go 2014; Chzhen e al. 2016a; Chzhen and Fe one 2016).
Unlike o he MODA s udies, he p esen analysis mos ly ocuses on non-ma e ial, ela ional
aspec s o child dep i a ion, co esponding closely o uni e sal child en’s igh s embedded in
he CRC. As such, hese aspec s could be used o de elop na ionally ailo ed measu es o
mul idimensional adolescen dep i a ion o moni o p og ess owa ds eaching sus ainable
de elopmen goals (“SDGs”), goal 1, a ge 1.2 o his age g oup. All coun ies o he wo ld
signed up o educe “a leas by hal he p opo ion o men, women and child en o all ages
li ing in po e y in all i s dimensions acco ding o na ional de ini ions.” Mos coun ies a e ye
o ag ee on he na ional de ini ions o mul idimensional po e y, so he p esen s udy illus a es
he po en ial o de eloping an adolescen -speci ic mul idimensional measu e.
The s udy highligh s subs an ial c oss- egion a ia ion in he p e alence o adolescen
dep i a ions. No dic coun ies had he lowes le els o mul idimensional dep i a ions among
adolescen s. Sweden, No way, Denma k, Finland and Iceland all had 15% o less o
adolescen s dep i ed in h ee o mo e dimensions ou o six. Only he Ne he lands had
compa ably low le els o mul iple dep i a ions. T adi ionally, hese a e coun ies wi h
consis en ly be e ou comes in many indica o s o child well-being (Kame man e al. 2003;
B adshaw and Richa dson 2009). Al hough Sweden ecen ly anked below a e age on
inequali y o child ou comes ac oss 41 OECD and EU coun ies (UNICEF 2016), in ou s udy
i had he lowes p opo ion o adolescen s dep i ed om a poo school en i onmen , poo
amily en i onmen as well as mul iple dep i a ions ( h ee plus). The di e ence be ween ou
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esul s and hose om UNICEF could be explained by he me hodological di e ences in
measu es (ou comes s. social ela ionships). F ancophone egions (Wallonia and F ance)
show a ela i ely high concen a ion o dep i a ion among adolescen s (bo h coun ies a e in
he op 5 o egions wi h he highes pe cen ages o dep i a ion in h ee o mo e dimensions),
compa able only o Bulga ia, La ia and Russia, coun ies wi h lowe le els o economic
de elopmen . This is somewha in line wi h indings o he ecen UNICEF (2016) epo ,
which anked F ance and Belgium in 28 h and 29 h place ou o 41 coun ies on inequali y in all
dimensions (income, educa ion, heal h and li e-sa is ac ion).
Al hough he e we e limi s o c oss- egional compa abili y o he esul s due o cul u al
di e ences and no ms ela ed o amily and pee ela ionships, ou indings unde line ha he
mo e subjec i e single aspec s o child dep i a ion do no a y wi h na ional weal h and income
inequali y. Howe e , mo e income unequal coun ies ended o ha e highe sha es o
adolescen s dep i ed in h ee o mo e dimensions. This is an impo an inding in he ligh o
pos -2015 SDG agenda o educing inequali y wi hin and among coun ies.11
Only o bo h indica o s o pe cei ed heal h, consis en gende di e ences we e ound
in all coun ies, wi h gi ls being mo e dep i ed han boys. Fo he o he dimensions, esul s
e ealed gende di e ences in only some o he coun ies (and o en in opposing di ec ions).
These indings a e consis en wi h ea lie s udies showing ha gi ls ha e a poo e pe cep ion
o hei heal h (Ca allo e al. 2006; Inchley e al. 2016; Chzhen e al. 2016b). Rema kably,
mul idimensional dep i a ion ( h ee o mo e domains) was mo e common o gi ls han o
boys in 60 pe cen o he coun ies, showing ha gi ls a e mo e ulne able o mul iple
dep i a ions han boys.
The isk o dep i a ion was no only la ge o gi ls bu also o adolescen s ha
pe cei ed hei amily a luence as ela i ely low and hose om non- wo-pa en amilies.
These links we e no only ound o all single dimensions o dep i a ion bu also o he
likelihood o acing a leas h ee ypes o dep i a ion. Di e ences acco ding o pe cei ed
amily weal h we e la ge han age and amily s uc u e ac oss all egions. Al hough he
associa ions be ween amily backg ound and adolescen heal h beha io and ou comes a e well
es ablished in he li e a u e (Cu ie e al. 2008; Elga e al. 2015b), his is he i s HBSC-based
s udy o show ha ulne abili ies o adolescen s om lowe pe cei ed socio-economic s a us
amilies go beyond indi idual aspec s o adolescen s’ li e o also explaining he
mul idimensionali y o hese expe iences.
11 h ps://sus ainablede elopmen .un.o g/sdg10.
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The esul s o his s udy show he in e connec edness o speci ic psychological and
social dep i a ions. Mo e speci ically, a lack o pe cei ed suppo in school and amily
coincided mos o en wi h expe iences o being bullied and poo heal h, while nu i ion and
in o ma ion access a e less likely o be in e connec ed wi h hese dimensions o dep i a ion. I
migh be ha adolescen s who lack good communica ion and suppo a school and amily a e
likely o become ic ims o bullying and su e om poo heal h. The e is no claim o causali y
o di ec ion o hese associa ions, bu om policy pe spec i e hey d aw a en ion o a g oup
o adolescen s who a e ma ginalised o excluded wi hin he school en i onmen as hese
adolescen s and young people a e ulne able in all hei social ies and connec ions du ing hei
adolescen li es.
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