Constructing and validating an index of alienation as predictor of high-symptom load among Danish adolescents

Background
Alienation is a well-known risk factor for deviant behaviour
among adolescents but only few studies regarding alienation as a
health risk factor exist. The present study developed and
validated an index of alienation towards one’s self, and those
closest to one’s self in an attempt to examine its association with
symptom load among adolescents.

Methods
Analyses were based on cross-sectional data from 5.205 school
children aged 11–15 years taken from a representative section
of schools in Denmark. The 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)
intercorrelation of the items, (iii) correlation between outcome
measures and each item of the index, and (iv) no differential item
functioning. The final index consisted of three indicators of
alienation: helplessness, feeling left outside, and a low degree of
confidence with parents. Symptom load was measured by HBSC
Symptom Checklist and divided into physical and psychological
symptoms, respectively. Symptoms were defined as at least one
symptom on a nearly daily basis. The final analyses comprised
multiple logistic regression analyses adjusting for sex, parent’s
socioeconomic position, being bullied, and loneliness.

Results
The odds-ratio (OR) for physical as well as psychological
symptoms was higher with increase in the degree of alienation.
For students who experienced all three indicators of alienation,
the OR for at least one nearly daily physical symptom was 2.49
(95% CI ¼ 1.05–5.87). OR for at least one nearly daily
psychological symptom was for the corresponding degree of
alienation 6.50 (95% CI ¼ 3.11–13.56).

Conclusions
The new index of alienation fulfilled psychometric criteria for
scalability and was strongly associated with high-symptom load
among adolescents. The results suggest that alienation should be
considered in future efforts aiming to enhance the health status
of adolescents.