Confidentiality matters! Adolescent males’ views of primary care in relation to psychosocial health: a structural equation modelling approach

Figures & data

Table 1. Characteristics of the study population.

Characteristics	GP visitors^a (n = 1,200)	Non-visitors^b (n = 1,049)	Missing	p-value^c
	n (%)	n (%)	n (%)
Grade			0 (0.0)	0.305
Y9^d	562 (46.8)	514 (49.0)
Y2U^e	638 (53.2)	535 (51.0)
Parents’ country of birth^f:			116 (4.9)	0.031
Sweden	926 (80.8)	843 (83.6)
Other country in Europe	60 (5.2)	61 (6.1)
Country outside Europe	160 (14.0)	104 (10.3)
Parents’ occupation:			183 (7.8)	0.927
Both parents work or study	912 (82.2)	812 (82.8)
One parent unemployed or on sick leave	174 (15.7)	148 (15.1)
Both parents unemployed or on sick leave	23 (2.1)	21 (2.1)
Family situation:			0 (0.0)	0.805
Living with both parents	704 (58.7)	622 (59.3)
Living with separated parents	425 (35.4)	360 (34.3)
Other	71 (5.9)	67 (6.4)
Chronic diseases or disabilities:
Somatic chronic disease^g	228 (19.3)	132 (12.8)	41 (1.7)	<0.001
Physical disability^h	162 (14.0)	93 (9.1)	91 (3.9)	<0.001
Dyslexia	152 (13.7)	120 (12.2)	177 (7.5)	0.312
ADHD^i or autism spectrum disorders	113 (10.0)	66 (6.7)	149 (6.3)	0.005

^aGP visitors: adolescent males who reported that they had visited a general practitioner (GP) once or more often during the past year. The sum of the GP visitors and the Non-visitors do not equal the total number of respondents (n = 2358), due to missing (n = 109, 4.6%).

^bNon-visitors: adolescent males who reported that they had not visited a GP during the past year (including those who did not know).

^cDifference between adolescent males who had visited a GP during the past year (GP visitors) and those who had not (non-visitors) analysed using Pearson’s chi-squared test.

^dY9: year 9 compulsory school.

^eY2U: year 2 upper secondary school.

^fIf the parents had different countries of birth, the country geographically closest to Sweden is reported as recommended by Statistics Sweden.

^gSomatic chronic disease includes asthma, diabetes mellitus, epilepsy, inflammatory bowel disease, and severe allergy. The response options No; Yes, mild; and Yes, severe, were available.

^hPhysical disabilities included are impaired hearing, mobility, or vision (not correctable with glasses).

ⁱAttention-Deficit/Hyperactivity Disorder.

Table 2. Description of male adolescent GP visitors’ and non-visitors’ behaviours, experiences and symptoms that compose four latent variables and four manifest variables.

The included variables, translated verbatim from the questionnaire	Available response options^a	GP visitors^b n = 1200 n (%)^f	Non-visitors^c n = 1049 n (%)^f	Total^d n = 2358 n (%)^f	Missing n (%)	p-value^e
Have you visited a general practitioner during the past year?	Yes, once, Yes, several times | No, Do not know	1200 (100.0)	0 (0.0)	1200 (53.4)	109 (4.6)
Unsafety
Do you feel safe…
…in the classroom?	Often or always, Sometimes | Seldom or never	22 (1.9)	15 (1.5)	38 (1.7)	120 (5.1)	0.448
…in school between classes?	Often or always, Sometimes | Seldom or never	24 (2.0)	20 (2.0)	46 (2.0)	102 (4.3)	0.885
…on your way to and from school?	Often or always, Sometimes | Seldom or never	22 (1.9)	13 (1.3)	36 (1.6)	83 (3.5)	0.258
…at home?	Often or always, Sometimes | Seldom or never	21 (1.8)	10 (1.0)	31 (1.4)	106 (4.5)	0.102
…during daytime, outdoors in your neighbourhood?	Often or always, Sometimes | Seldom or never	23 (1.9)	20 (1.9)	45 (2.0)	74 (3.1)	0.977
…during night-time, outdoors in your neighbourhood?	Often or always, Sometimes | Seldom or never	39 (3.3)	29 (2.8)	73 (3.2)	82 (3.5)	0.501
Gloominess
Do you enjoy life right now?	A great deal, Quite a bit | A little bit, Not at all	97 (8.3)	69 (6.7)	176 (7.8)	101 (4.3)	0.168
How is your general health?	Excellent, Good, Fair | Poor, Very poor	38 (3.2)	25 (2.4)	69 (3.0)	30 (1.3)	0.255
During the last three months, how often did you feel cheerful?	Seldom or never, Once a month, Once a week | More than once a week, Almost every day	116 (9.9)	91 (8.9)	217 (9.5)	63 (2.7)	0.438
Are you satisfied with your spare time?	Very satisfied, Rather satisfied, Neither satisfied nor unsatisfied | Rather unsatisfied, Very unsatisfied	41 (3.5)	35 (3.4)	83 (3.6)	54 (2.3)	0.897
In your spare time, how many times a week do you exercise at least 30 min vigorously enough to make you sweat?	Every day, 4–6 times a week, 2–times a week, Once a week | 1–3 times a month, Less than once a month, Never	240 (20.5)	272 (26.5)	536 (23.4)	65 (2.8)	0.001
Do you enjoy school?	A great deal, Quite a bit, Somewhat | A little bit, Not at all	51 (4.3)	41 (4.0)	100 (4.3)	47 (2.0)	0.659
Pain
During the last three months, how often have you had…
…headache (not counting migraine)?	Seldom or never, Once a month, Once a week | More than once a week, Almost every day	108 (9.4)	70 (7.0)	184 (8.2)	121 (5.1)	0.042
…pain in your neck or shoulders?	Seldom or never, Once a month, Once a week | More than once a week, Almost every day	160 (14.1)	99 (10.0)	269 (12.2)	148 (6.3)	0.003
…pain in your back or hips?	Seldom or never, Once a month, Once a week | More than once a week, Almost every day	171 (15.1)	91 (9.1)	272 (12.3)	146 (6.2)	<0.001
…stomach ache?	Seldom or never, Once a month, Once a week | More than once a week, Almost every day	87 (7.7)	44 (4.4)	135 (6.1)	144 (6.1)	0.002
Deviancy
Do you smoke?	No, Have tried, Have stopped | Sometimes, Daily,	206 (17.4)	158 (15.2)	384 (16.5)	37 (1.6)	0.166
During the last 12 months, how often have you been drinking alcohol?	Never, Once, A few times every six months | 1 to 3 times a month, 1–2 times a week, More than 2 times a week	314 (26.7)	221 (21.5)	561 (24.5)	66 (2.8)	0.005
How many times have you ever used illegal drugs?	Never | Once, Twice or more	189 (16.1)	133 (12.8)	338 (14.7)	56 (2.4)	0.032
During your last sexual intercourse, did you use any contraception?	Condom, Birth control pill, Contraceptive implant, Other, Emergency contraception, Not yet had their first sexual intercourse | No contraception was used	115 (10.1)	83 (8.3)	209 (9.4)	143 (6.1)	0.141
Do you regularly skip class?	No, Once a semester, Once a month, 2–3 times a month| Once a week, Twice a week or more	51 (4.3)	49 (4.7)	108 (4.7)	55 (2.3)	0.637
Have you ever…
…taken goods from a shop without paying?	Never, Once, 2–5 times | More than 5 times	110 (9.6)	86 (8.5)	207 (9.3)	131 (5.6)	0.393
…broken into a house or a car?	Never | Once, 2–5 times, More than 5 times	170 (14.9)	101 (10.0)	286 (12.9)	141 (6.0)	0.001
…bought or sold anything you knew, or thought was stolen?	Never | Once, 2–5 times, More than 5 times	148 (13.1)	81 (8.1)	241 (11.0)	163 (6.9)	<0.001
…threatened or forced someone to give you money, a cell phone or similar?	Never | Once, 2–5 times, More than 5 times	50 (4.4)	20 (2.0)	72 (3.2)	140 (5.9)	0.002
…on purpose hit anyone hard enough to cause an injury or bleeding?	Never | Once, 2– times, More than 5 times	376 (32.9)	210 (21.0)	604 (27.3)	147 (6.2)	<0.001
Impaired connectedness
Can you talk about things that you worry about with…
…your mother?	Yes it is easy, It is neither easy nor difficult | No it is difficult, I do not see her	198 (17.0)	176 (17.1)	392 (17.1)	72 (3.1)	0.930
…your father?	Yes it is easy, It is neither easy nor difficult | No it is difficult, I do not see him	302 (26.6)	253 (25.0)	575 (25.8)	127 (5.4)	0.418
…other close adult?	Yes it is easy, It is neither easy nor difficult | No it is difficult, I have no such adult	383 (35.3)	349 (36.0)	755 (35.3)	218 (9.2)	0.736
Do you have a close friend that you can talk to about everything?	Yes several close friends, Yes one | None	159 (13.6)	149 (14.6)	316 (14.0)	104 (4.4)	0.508

Source: Life and Health in Youth 2014.

^aThe responses were dichotomized for readability, with a vertical bar marking the cut-off. Affirmative reports of the response options in italics were summed and are shown as frequencies and proportions.

^bGP visitors: Adolescent males, who reported that they had visited a general practitioner once or more often during the past year.

^cNon-visitors: Adolescent males, who reported that they had not visited a general practitioner during the past year (including those who did not know).

^dTotal: Adolescent males from year 9 compulsory school and year 2 upper secondary school, including those who did not answer the question about visiting a general practitioner (n = 109).

^ePearson’s chi-squared test.

^fFrequencies and proportions of affirmative responses conforming to any of the italicized options, indicating exposure or negative outcome. Due to missing responses to the question about visiting a general practitioner during the past year (n = 109, 4.6%), the sum of GP visitors and Non-visitors do not equal the n in Total.

Figure 1. Structural models to study confidentiality and being comfortable asking sensitive questions in relation to mental health (unsafety, gloominess, and pain) and health-compromising behaviours (deviancy). Note that the cross-sectional design limits conclusive evidence regarding the causality in the relationships. Adjustment variables and allowed covariances are shown in Appendix A, Figure A1.

^aModel 1 was used for seven outcomes: valuing private time, valuing secrecy explained, experienced private time, experienced secrecy explained, being comfortable asking about body and appearance, love and relationships, and sex.

^bModel 2, 3 and 4 were used for three outcomes: being comfortable asking about body and appearance, love and relationships, and sex.

Table 3. Experienced confidentiality (no, yes) and being comfortable asking sensitive questions (no, partly, yes) in relation to poor mental health and health-compromising behaviours among adolescent males, shown as approximative odds ratios.

	Experienced confidentiality		Comfortable asking sensitive questions
	Private time (no, yes)	Secrecy explained (no, yes)	Comfortable asking about body and appearance (no, partly, yes)				Comfortable asking about love and relationships (no, partly, yes)				Comfortable asking about sex (no, partly, yes)
	appOR^a (p-value)	appOR^a (p-value)	appOR^a (p-value)				appOR^a (p-value)				appOR^a (p-value)
Model^b	Model 1	Model 1	Model 1	Model2	Model 3	Model 4	Model 1	Model2	Model 3	Model 4	Model 1	Model2	Model 3	Model 4
Confidentiality
Experienced private time				1.68 (< 0.001)		1.54 (< 0.001)		1.60 (< 0.001)		1.43 (< 0.001)		1.56 (< 0.001)		1.43 (< 0.001)
Experienced secrecy explained					1.47 (< 0.001)	1.25 (0.010)			1.53 (< 0.001)	1.34 (0.001)			1.43 (< 0.001)	1.25 (0.008)
Poor mental health
Unsafety	1.00 (0.998)	0.97 (0.805)	0.85 (0.096)	0.85 (0.094)	0.85 (0.108)	0.85 (0.100)	0.86 (0.111)	0.86 (0.115)	0.87 (0.125)	0.87 (0.122)	0.87 (0.119)	0.87 (0.123)	0.87 (0.130)	0.87 (0.128)
Gloominess	1.02 (0.862)	0.96 (0.721)	1.09 (0.394)	1.08 (0.427)	1.09 (0.344)	1.09 (0.389)	1.03 (0.728)	1.03 (0.772)	1.04 (0.649)	1.04 (0.705)	1.00 (0.970)	0.99 (0.925)	1.01 (0.961)	1.00 (0.977)
Pain	1.03 (0.755)	1.03 (0.722)	1.16 (0.062)	1.15 (0.078)	1.15 (0.071)	1.15 (0.080)	1.13 (0.118)	1.12 (0.139)	1.12 (0.135)	1.12 (0.144)	1.11 (0.161)	1.10 (0.184)	1.10 (0.183)	1.10 (0.192)
Health-compromising behaviours
Deviancy	1.16 (0.080)	1.26 (0.005)	1.04 (0.594)	0.99 (0.933)	0.99 (0.869)	0.97 (0.699)	1.16 (0.050)	1.11 (0.160)	1.09 (0.231)	1.08 (0.307)	1.30 (0.001)	1.25 (0.003)	1.24 (0.004)	1.22 (0.007)
Older age	1.42 (<0.001)	1.13 (0.069)	1.15 (0.022)	1.04 (0.571)	1.12 (0.065)	1.04 (0.549)	1.08 (0.234)	0.98 (0.699)	1.04 (0.490)	0.98 (0.728)	1.11 (0.078)	1.02 (0.814)	1.09 (0.181)	1.02 (0.789)
Impaired connectedness
Difficulties talking about worries with…
…mother	0.94 (0.470)	1.03 (0.755)	0.87 (0.047)	0.88 (0.075)	0.86 (0.038)	0.88 (0.061)	0.88 (0.077)	0.90 (0.121)	0.88 (0.061)	0.89 (0.091)	0.88 (0.070)	0.90 (0.113)	0.88 (0.062)	0.89 (0.095)
…father	0.94 (0.469)	0.84 (0.031)	0.99 (0.855)	1.01 (0.936)	1.03 (0.748)	1.03 (0.742)	0.98 (0.821)	1.00 (0.980)	1.03 (0.719)	1.03 (0.712)	0.93 (0.283)	0.94 (0.409)	0.96 (0.569)	0.96 (0.571)
…other close adult	1.11 (0.181)	0.95 (0.437)	0.87 (0.029)	0.84 (0.007)	0.88 (0.043)	0.85 (0.012)	0.88 (0.049)	0.86 (0.014)	0.89 (0.076)	0.87 (0.028)	0.89 (0.062)	0.87 (0.021)	0.90 (0.091)	0.88 (0.035)
Absence of close friends	0.94 (0.430)	0.94 (0.342)	0.82 (0.002)	0.84 (0.005)	0.84 (0.005)	0.84 (0.006)	0.83 (0.003)	0.84 (0.006)	0.84 (0.006)	0.85 (0.008)	0.83 (0.002)	0.84 (0.004)	0.84 (0.004)	0.85 (0.005)

Source: Life and Health in Youth 2014.

^aApproximative odds ratios derived from regression coefficients in 14 SEM-analyses, each based on 20 imputed datasets (n = 1200). Significant associations are highlighted in bold type (p < 0.05).

^bModel 1: Each outcome was tested in relation to poor mental health and health-compromising behaviours, and adjusted for grade (age) and impaired connectedness.

Model 2: Model 1 + experienced private time.

Model 3: Model 1 + experienced secrecy explained.

Model 4: Model 1 + experienced private time and experienced secrecy explained.

Figure 2. Proportions of adolescent males being comfortable asking about their body and appearance, love and relationships, or sex when visiting a general practitioner in relation to experienced confidentiality: if neither private time, nor secrecy explained were experienced; if secrecy explained was experienced; if private time was experienced; or both. Reports from 1200 Swedish adolescent males (Life and Health in Youth 2014).

Figure A1. The structural models to study confidentiality and being comfortable asking sensitive questions in relation to poor mental health and health-compromising behaviours, here shown with all included adjustment variables and covariances. Each outcome was tested in relation to poor mental health (unsafety, gloominess, and pain) and health-compromising behaviours (deviancy), adjusted for grade (as a proxy for age) and impaired connectedness (difficulties talking about worries with mother, father, or other close adult, and absence of close friends). Covariances were allowed between the four latent variables (unsafety, gloominess, pain, and deviancy) in all models and between experienced private time and experienced secrecy explained in Model 4.

^aModel 1 was used for seven outcomes: valuing private time, valuing secrecy explained, experienced private time, experienced secrecy explained, being comfortable asking about body and appearance, being comfortable asking about love and relationships, and being comfortable asking about sex.

^bModel 2, 3 and 4 were used for three outcomes: being comfortable asking about body and appearance, being comfortable asking about love and relationships, and being comfortable asking about sex.