Bullying Victimization and Subjective Health Complaints in Canadian Adolescents: Examining Spiritual Health Connections as Protective Heath Assets
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Background: Young people victimized by bullying may draw on assets such as spiritual health to protect them from harm. Composed of the connections in our lives (to ourselves, others, nature, or something transcendent), spiritual health may moderate pathways between bullying and symptoms of poor mental health, but this has yet to be explored among adolescents. Objectives: 1) Examine the structural validity of a 10-item Spiritual Health scale; 2) describe patterns in bullying victimization, health complaints and spiritual health; and 3) investigate if spiritual health connections act as effect modifiers in relationships between bullying victimization and subjective health complaints, as one indicator of impaired internalizing mental health. Differences between age and gender groups were also explored. Methods: Data were used from the 2017/18 Canadian Health Behaviour in School-aged Children study. Objective 1: Factor analyses examined the structural validity of the 10-item Spiritual Health Scale. Objective 2: The prevalence of key variables was examined in different age and gender groups. Objective 3: Modified Poisson regression models with robust error estimation were used to estimate the relative risk for the association between bullying victimization and subjective health complaints. These models also estimated effect modification by spiritual health in age and gender groups. Results: Objective 1: The latent structure of the Spiritual Health scale was consistent with the four theoretical domains. Objective 2: 21% of the total sample reported being bullied, with a higher prevalence among girls and younger students. Objective 3: Among girls, the strength of “connections to self” was found to act as an effect modifier. The strongest associations between bullying victimization and frequent health complaints were identified among girls with high connections to self. Relative risks for health complaints among these self-connected girls were 1.63 (95% CI: 1.26-2.12) and 1.25 (1.06-1.47) for younger and older girls, respectively. The same relationship was weaker in girls who placed lower importance on connections to self. Conclusion: Relationships between bullying victimization and frequent health complaints differed by the strength of “self-connections”, suggesting effect modification. Associations were strongest among girls reporting high importance of connections to self. This may have implications for future adolescent health promotion.