Association between physical and mental health in school-going adolescents: Sex-specific patterns of maladjustment in formative years of life

Adolescence is a turbulent period of rapid biopsychosocial changes that help transition to adulthood. Adolescence maladjustment shows sex-specific vulnerability such that internalizing pathologies are linked with depression-anxiety in females, whereas externalizing problems linked are with substance abuse and conduct disorders in males. Developing countries with patriarchal societies produce early gender-inequity that might impact physical health, family, and social environments of adolescents impacting adulthood. The link between sex-differences in physical health, social support (school & family) and adolescent problems in non-western context is unclear. Hence, adolescents from 19 schools (N = 5121, male = 48%, female = 39%, missing = 13%) filled Indian Adolescent Health Questionnaire to measure physical health, family, and social environment, Strengths and Difficulties Questionnaire was used for adjustment problems (internalizing-externalizing). Males reported better physical health and nutrition whereas females had better attitude towards safety, substance use, and academics. Physical health, family, school and social environment were correlated (p = .00), t-test showed sex-differences in all subdomains except hygiene and family environment. For adjustment problems, 22.8% of school students experienced borderline problems and 16% were categorized highly problematic, male students had higher maladjustment problems. Contrary to the West, internalizing problems showed no sex-differences, but male students' internalizing problems were due to peers. Partial correlation controlling sex and class showed that family support negatively correlated with emotion problems (r = - .05, p < .05), hygiene attitude positively correlated with hyperactivity problems (r = .033, p < .05). School intervention involving families might shield adolescents from mental health problems, targeting sex-specific risks such as nutrition and physical activity for females or drugs and safety for males might improve health. Using standard health measures might allow follow-ups for comparing health gender-gap across the developmental phases of individuals accounting for urban-rural divide accentuated in developing countries and diverse population.