{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T02:56:31Z","timestamp":1793674591956,"version":"4.5.1"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To examine whether there is a socioeconomic status (SES) gradient in adolescent mental health problems, and if so, whether out-of-school physical activity mediates this gradient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Based on data from 1,285 adolescents in Sweden, we used linear regression analysis to examine whether the social gradient in mental health problems (stress and psychosomatic symptoms by survey) varied by SES indicators, including income, father\u2019s and mother\u2019s education (register data). Parameter estimates were obtained using ordinary least squares. We also investigated if out-of-school physical activity (accelerometer data) mediates these gradients by applying the potential outcomes framework for mediation analysis. This framework accounts for potential exposure-mediator interaction, and confidence intervals were calculated using bootstrapping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Gradients in adolescents\u2019 mental health problems were observed for all SES indicators, the coefficient of determination R\n                      <jats:sup>2<\/jats:sup>\n                      showing the different SES indicators explained between 0.7\u20131.4% of stress and 0.5\u20131.2% of psychosomatic symptoms. Out-of-school vigorous-physical-activity (VPA) and moderate-to-vigorous-physical-activity (MVPA) partially mediated the gradients related to income in the overall sample. Specifically, VPA mediated 6.8% of the association between income and stress, and 9.2% of the association between income and psychosomatic symptoms, while MVPA mediated 5.4 and 6.6% of these associations, respectively. Regarding father\u2019s education, VPA mediated 15.7% of the association with stress and 10.2% with psychosomatic symptoms, whereas MVPA mediated 14.6 and 8.9%, respectively. Sex-stratified analyses revealed that these mediation effects were statistically significant only among females. For mother\u2019s education, mediation effects were observed exclusively in the female subgroup. VPA mediated 24.1% of the association with stress and 24.0% with psychosomatic symptoms, while MVPA mediated 20.8 and 21.5% of these associations, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There are social gradients in adolescents\u2019 mental health problems based on income and parents\u2019 education, and these gradients appear to be partially mediated via out-of-school VPA and MVPA, predominantly among females.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1622080","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T04:16:59Z","timestamp":1760329019000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Physical activity partially mediating the social gradient in adolescent mental health"],"prefix":"10.3389","volume":"13","author":[{"given":"Johan","family":"Dahlstrand","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinyun","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Friberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonatan","family":"Fridolfsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"ref1","year":"2023"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1186\/s12888-022-04432-x","article-title":"Among the Swedish generation of adolescents who experience an increased trend of psychosomatic symptoms. do they develop depression and\/or anxiety disorders as they grow older?","volume":"22","author":"Giannotta","year":"2022","journal-title":"BMC Psychiatry"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"101509","DOI":"10.1016\/j.ssmph.2023.101509","article-title":"Prospective associations between psychosomatic complaints in adolescence and depression and anxiety symptoms in young adulthood: a Swedish national cohort study","volume":"24","author":"Grigorian","year":"2023","journal-title":"SSM Ppopulat Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"14034948211008555","DOI":"10.1177\/14034948211008555","article-title":"Subjective health complaints in early adolescence reflect stress: a study among adolescents in Western Sweden","volume":"50","author":"Corell","year":"2021","journal-title":"Scand J Public Health"},{"key":"ref5","year":"2024"},{"key":"ref6","author":"Rolf Aaberge","year":"2018"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.socscimed.2013.04.026","article-title":"Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review","volume":"90","author":"Reiss","year":"2013","journal-title":"Soc Sci Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1136\/jech-2017-209784","article-title":"Trends in adolescent mental health during economic upturns and downturns: a multilevel analysis of Swedish data 1988-2008","volume":"72","author":"Kim","year":"2018","journal-title":"J Epidemiol Community Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1472","DOI":"10.3389\/fpsyg.2020.01472","article-title":"Trends in socioeconomic inequalities in Norwegian adolescents' mental health from 2014 to 2018: a repeated cross-sectional study","volume":"11","author":"Myhr","year":"2020","journal-title":"Front Psychol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1136\/jech.2005.041319","article-title":"Education, income, and occupational class cannot be used interchangeably in social epidemiology. 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