2012. Vol.3, No.2, 123-127
Published Online February 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.32018
Copyright © 2012 SciRes. 123
The Influence of Optimistic Expectations and Negative Life
Events on Somatic Symptoms among Adolescents: A One-Year
Terje Arnfinn Murberg
University of Stavanger, Stavanger, Norway
Received October 20th, 2011; revised December 9th, 2011; accepted January 12th, 2012
This study prospectively examined the main effect of optimism on subsequent somatic symptomatology
as well as optimism as moderating factors in the link between negative life events and somatic symptoms
in a sample of 198 (111 females, 87 males) students in a Norwegian senior high school. Results from the
longitudinal multivariate analyses, indicated that the scores for optimism and negative life events were
significantly associated with scores of somatic symptoms at time-point two (T2). Moreover, a significant
Optimism × Negative life events interaction was found in predicting somatic symptoms. Implications of
these findings are discussed.
Keywords: Optimism; Negative Life Events; Somatic Symptoms; Senior High School Students
Physical symptoms of unknown pathology have haunted
medical and mental health practitioners for centuries. Somatisa-
tion problems often start in adolescence and continue into adult
life. It is estimated that 10% to 15% of all youngsters report
somatic complaints (Campo & Fritsch, 1994, Ryan-Wenger,
1994). In addition to their high prevalence, finding indicate that
somatic symptoms are associated with high levels of co-morbid
psychological symptoms, like anxiety and depression (Haug,
Mykletun, & Dahl, 2004), as well as high levels of functional
impairment (Mulvaney et al., 2006; Aromaa et al., 2000). Given
that these symptoms are linked to poor adaption during adoles-
cence, such as decreased work and school productivity (Aro,
1987) and increased used of the health care system, under-
standing early risk and protective factors for somatic symptoms
is crucially important (Di Lorenzo et al., 2005).
Different theoretical approaches have dominated the research
in understanding somatic symptomatology. Empirical support
has been found for the idea that life events perceived as nega-
tive or stressful for individuals have the potential to produce
somatic symptoms. Adolescence is a challenging period of life
that includes experience of stressful life events that may be
critical for the individual’s developmental and psychological
adjustment. Different acute or chronic stressful life events im-
pose demands that some people are unable to cope with. Such
negative experiences are considered to put individuals at risk
for psychological and physical problems. A number of studies
have reported a significant association between stressful life
events and somatic symptoms among adolescents (Boey & Goh,
2001; Walker, Garber, & Greene, 1994). Longitudinal studies
exist indicating that negative life events are associated with
psychological and physical health problems in adolescents (see
Waaktaar et al.; Ystgaard, Tams, & Dalgaard, 1999). However,
it is not the experience of stressful life events per se that is
necessarily harmful, but often the individual’s inability to cope
adequately with various stressful events that have a negative
impact on the adolescent’s health and well-being. Unpredict-
able or disruptive environments may undermine an adolescent’s
sense of control and mastery, leading to a sense of helplessness
and/or hopelessness that acts as a precursor to somatic symp-
tomatology. It is therefore predicted that the experience of
negative life events would increase the risk of somatic symp-
toms in this sample of mid-adolescents.
While stress is a part of the adolescent’s life, the same nega-
tive life event may not be perceived as equally stressful by
different individuals. The experience of stress is influenced by
the individual’s perception and interpretations (Lazarus &
Folkman, 1984). Some researchers have considered the role of
cognitive-affective factors, which may facilitate coping with the
demands imposed by stressful life events, and consequently
ameliorate the potentially negative influences of stressful life
events and thus be protective (Skodol, 1998). Dispositional
optimism, which is conceptualized as the generalized tendency
to expect positive outcomes in the future, even under stressful
situations (Scheier, Carver, & Bridges, 2000), is one internal
personality factor which may influence the way a person ap-
praises negative life events, his or her reactions to the events,
and thus the outcomes (Mäkikangas & Kinnunen, 2003). Thus,
dispositional optimism should be considered as a protective
factor for somatic health problems (Mosing et al., 2010; Chang
& Sanna, 2003). The individual’s optimistic view may provide
ongoing feelings of security, positive affect, and self-efficacy.
Consequently, optimists may expect to cope effectively with
stressful life events, whereas pessimists are those who do not
expect to cope successfully (Scheier & Carver, 1985, 1992).
Optimists are reported to use more active, problem-focused
coping strategies in managing stressful events, whereas less
optimistic individuals are likely to adopt avoidance strate-
gies in similar situations (Scheier & Carver, 1985). The
abilities to cope actively may reduce the adverse physio-
T. A. MURBERG
logical effects of negative life events (Taylor et al., 2000). In a
study of students entering college, Aspinwall and Taylor (1992),
found that optimistic students were likely to use active coping,
which in turn predicted better adjustment to college. Thus, it is
predicted that somatic symptoms will be less pronounced
among adolescents scoring high on optimism, compared with
their more pessimistic counterparts.
However, studies of optimism have been found to moderate
the association between stressful life events and psychological
and physical adjustment outcomes among adolescents (Lai,
2009; Chang & Sanna, 2003; Chang, 1998b). The buffer or
moderator effects of optimism imply that adolescents who re-
port high levels of stress, but are likely to have positive emo-
tional reactions and expectations, may be more likely to be
protected from the negative effects of life stressors than those
who are more pessimistic. However, relatively little research
has focused on the role that optimism plays in the mitigation of
stressful events and the reduction of psychopathology, and most
studies that have examined the effects of optimism on adoles-
cent’s health have been cross-sectional. Consequently, devel-
opmental and causal conclusions have been somewhat tenuous.
Therefore, more prospective studies are needed to investigate
the potential buffering effects of optimism on somatic symp-
toms among late adolescents. In the present study, we examined
the stress buffering effects of optimism in a sample of adoles-
cents in senior high school who experienced negative life
events. The specific hypothesis is that a Negative life events
Optimism interaction reduces the effects of negative life events
on somatic symptoms among adolescents scoring high on opti-
In summing up, the purpose of the present study was to 1)
examine the relationship between optimism, negative life
events, and somatic symptoms; and 2) determine whether opti-
mism moderates the link between negative life events and so-
It is well documented across disciplines that children with
somatic symptoms display elevated levels of psychological
symptoms, such as depression or anxiety (Garber, Walker, &
Zeman, 1991; Egger, Angold, & Costello, 1998), and that the
frequency of somatic symptoms tends to increase with the se-
verity of anxiety and depressive symptoms (Dhossche et al.,
2001). Depressive symptoms were therefore included as a co-
variate in the present study.
The sample consisted of senior high school students who
were 16 - 18 years old at baseline. The sample was recruited
from one senior high school in a city in South West Norway.
Participation in the study was voluntary and required both writ-
ten parent and student consent. Consent was obtained from 87%
of the eligible students in the school. Data were collected at two
time points. The second assessment (T2) occurred 1 year after
the first (T1) assessment in the same winter month of each year.
The present analyses were based on those 198 students who
returned valid questionnaires at both waves, which constitutes
50% of the original sample. Most of the attrition from the
original sample was a result of many students at T1 leaving
school at T2 to study at other senior high schools in the county.
Attrition analyses showed that there were no significant differ-
ences between those who completed the study and those who
did not complete the study on any of the study variables at
Respondents were asked to complete a questionnaire during
an ordinary 45-minute classroom period with a teacher present.
Students did not enter their names on the questionnaires and
were assured of anonymity. Each student’s school identification
number was used to identify and track the questionnaire that
she or he completed. To reduce the risk of students influencing
each other’s responses, the questionnaires were administered,
as far as possible, at the same time for each class in every
Dispositional optimism. Optimism was assessed by the re-
vised life orientation scale (LOT-R; Scheier, Carver, & Bridges,
1994). This scale assesses trait-like optimism and pessimism
via general dispositional outcome expectancies of the respon-
dent. It consists of 10 statements (3 positively worded, 3 nega-
tively worded and 4 filler items) and requires participants to
indicate how strongly they agree with each statement using a
five-point Likert-type scale ranging from 0 (strongly disagree)
to 4 (strongly agree). Examples of items include: 1) In uncer-
tain times, I usually expect the best; 2) If something can go
wrong for me, it will; and 3) I’m always optimistic about my
future. Negatively worded items are reverse scored and all
items are summed to create an overall score; filler items are not
included in the total score. Higher scores indicate increased
optimism. Chronbach’s alpha for this scale on dispositional
optimism in the present study was 0.82.
Negative life events. Negative life events were assessed by a
checklist constructed on the basis of an established life events
list for adolescents (Swearingen & Cohen, 1985). The scale has
been used several times among senior high school Norwegian
adolescents (Ystgaard, 1997; Ystgaard, Tams, & Dalgard,
1999). This instrument included 10 items illustrative of life
events. Items that were covered, included parents divorcing or
remarrying, parents becoming unemployed or disabled, self
becoming ill or injured serious illness among close relatives or
friends, unhappy love affair and self being harassed. Responses
to items were given in two sections. In the first section, students
were asked to indicate if they had experienced such an event on
a dichotomous scale (Yes/No). In the second section, students
were asked to appraise the strain they experienced due to the
events using a five steps scoring format ranging from “little” to
“very much”. Chronbach’s alpha for the scale on negative life
events in the present study was 0.76.
Somatic symptom. Somatic symptoms were assessed on the
basis of six items from the Ursin Health Inventory (UHI: Ursin,
Endresen, & Ursin, 1988) and five items from the Hopkins
Symptoms Checklist (HSCL: Derogatis et al., 1974). These
items all had a four-step scoring format with the following re-
sponse categories: “no complaints”, “mild complaints”, “mod-
erate complaints” and “severe complaints”. The six UHI-items
of psychosomatic symptoms were combined with those from
the HSCL to compute index-scores for different psychosomatic
symptoms. The index on exposure to psychosomatic symptoms
had a Cronbach’s alpha of 0.79 in the present study.
Copyright © 2012 SciRes.
T. A. MURBERG
Depressive symptoms. Depressive symptoms were assessed
on the basis of seven items that covered depressive complaints
(“feeling low in energy”, “slowed down”; “crying easily”,
“feeling blue”; “feeling no interest in things”; “feeling every-
thing is an effort”; “poor appetite”, and “difficulty falling
asleep or staying asleep”) from the 25-item version of the Hop-
kins Symptoms Checklist (Derogatis et al., 1974; Winokur et al.,
1984). Exploratory as well as confirmatory factor analyses
indicate that these items assess a uniform construct. Explora-
tory factor analyses, implementing principal axis factoring,
oblique rotation and eigenvalue set to 1, yielded a one-factor
solution for the items that were implemented to assess depres-
sive symptoms. This factor structure was tested by confirma-
tory factor analysis implementing maximum likelihood estima-
tion. The analysis indicated a close fit for the one-factor solu-
tion [RMSEA = 0.038; 90% CI = (0.000, 0.063)]. The scale of
depressive symptoms had a Cronbach’s alpha of 0.82. These
items all had four-step scoring formats with the following re-
sponse categories: “no complaints”, “mild complaints”, “mod-
erate complaints” and “severe complaints”.
The selected statistical tools were descriptive analyses, pro-
duct-moment-correlations, reliability testing (Cronbachs alpha),
exploratory factor analysis, confirmatory factor analysis, and
multiple regression analysis. Statistical analyses were con-
ducted using SPSS-PC package, version 17 (Norusis, 2008) and
AMOS (Arbuckle & Wothke, 1999).
Table 1 presents the Pearson product-moment correlations
between study variables at T1. As can be seen from the table,
scores on the LOT-R were significantly, negatively correlated
with negative life events, somatic symptoms, and depressive
symptoms. As expected, a relatively strong positive association
between negative life events and somatic symptoms appeared.
For the covariate depressive symptoms, a significant, positive
association with somatic symptoms and negative life events
A multiple regression analysis with two sections was con-
ducted in order to explore the prospective effect of optimism
and negative life events at T1 on T2 levels of somatic symptoms,
controlling for initial level of somatic symptoms and depressive
symptoms. In the first section, optimism and negative life
events were entered simultaneously to test the main effects of
each of these variables, controlling for T1 depressive symptoms.
The R2s, standardized β, and p values are presented in Table 2.
Pearson’s intercorrelations between different study variables at T1 (N =
Variables 1 2 3 4
1. Optimism -
2. Negative life events –0.29*** -
3. Somatic symptoms –0.19** 0.43*** -
4. Depressiv e symptoms –0.32*** 0.42*** 0.63*** -
Note: ***p < 0.0001; **p < 0.00 1.
Result from multivariate regression analyses for the prospective effects
of optimism, negative life events, depressive symptoms at T1 on so-
matic symptoms at T2 (controlling for initial somatic symptoms), as
well as interaction effects of optimism and negative life events on so-
matic symptoms at T2 (N = 198).
Variables Standardized β p
Negative life events 0.371 0.000
Somatic symptoms 0.362 0.000
Depressive symptoms 0.044 n.s
R2 0.427 0.000
Optimism × Negative life events
Overall R2 0.460 0.000
Results from this prospective analysis indicated a significant,
negative effect of optimism on subsequent somatic symptoms,
whereas for negative life events and initial level of somatic
symptoms, a significant, positive effect on somatic symptoms
at T2 was found. In the second section, as a test of the stress-
buffering effects, significant negative interactions with negative
life events were found for optimism. The increment in R2 was
3.3%. Overall, the entire set of predictor variables accounted
for 46.0% of the variance in T2 somatic symptoms.
Relatively few prospective studies have been designed to as-
sess the effects of optimism on subsequent somatic symptoms
among students in senior high school exposed to stressful life
events. Thus, the first objective of this investigation was to
examine the relationships among optimism and somatic symp-
tomatology in a sample of senior high school students. Results
from the multiple regression analyses showed that a high score
on optimism was significantly and negatively related to somatic
symptoms obtained one year later. This association was evident
even when controlling for initial symptomatology and negative
life events, as well as for the covariates of depressive symptoms.
The present findings are consistent with previous research on
optimism among adolescents (Chang & Sanna, 2003; Lai,
2009), and lend support to the prediction that students reporting
high level of optimism would be less likely to complain about
somatic symptoms, compared to those reporting low levels of
optimism. This finding is of interest because few prospective
studies among senior high school students have reported sig-
nificant effects of optimism on later symptomatology. A possi-
ble explana tion may be that optimism infl uences physica l well-
being by fostering adaptive behaviours and cognitive responses
that are associated with greater flexibility, problem-solving
capacity and a more realistic appraisal of negative information.
Notwithstanding, the most interesting finding from the pre-
sent study was the significant interaction effect of optimism on
the relationship between negative life events and somatic
symptoms. This finding suggests that an optimistic outlook may
be beneficial in buffering the negative effects of stressful life
events on somatic symptomatology among the students who are
exposed to stressful circumstances in their life. One possible
Copyright © 2012 SciRes. 125
T. A. MURBERG
explanation for the buffer effect of optimism may be related to
the expectations of this optimism in coping with negative life
events. When faced with stressful life events, optimists may be
likely to believe that positive outcomes are attainable and also
to have high expectations of themselves in coping with stressful
events, and invent greater efforts to achieve their goals. Unlike
pessimistic individuals who tend to use emotion-like coping
strategies, optimistic individuals are likely to employ more
adaptive coping strategies, such as active and problem-focused
coping (Scheier & Carver, 1985; Mäkikangas & Kinnunen,
The presence of protective effects of optimism on somatic
symptoms provides support for promoting an optimistic view in
adolescents. Recognising the buffering effects of optimism on
adolescents could encourage professionals to make more use of
this internal psychological resource to alleviate the adverse
impact of stressful events on physical health. The teaching of
coping skills that can improve adolescent’s abilities to handle
life demands more effectively may reduce reported somatic
symptoms. This may involve adolescents in setting their own
goals and developing strategies for overcoming difficulties in
Apart from optimism, previous studies have shown that per-
sonality attributes like self-esteem (Mäkikangas & Kinnunen,
2003), as well as different sources of social support (Murberg
& Bru, 2009; Brisette et al., 2002), moderate the negative im-
pact of stressful events on health among adolescents. Further
studies addressing other potential stress moderators together
with optimism could provide a better understanding on the role
that these factors play in alleviating the negative effects of
stressful events on adolescent health.
As stressful life events can lead to increased health costs,
higher rates of absence from school and lower performance
among the adolescents, it is appropriate to design school-based
programmes for those who report high levels of negative life
events, as well as for students in general. Such programmes
should promote optimistic thinking and seek to modify the
school and life environment of stressed students in order to
reduce disturbing life experiences. There needs to be both pre-
ventative and interventionist dimensions in these programmes.
That way, teachers, school psychologists and other profession-
als will be able to promote a healthy school climate in which
stressors are moderated, while at the same time intervening
directly when acute problems arise.
Turning to methodological considerations, some things have
to be taken into account. A limitation of the present study is
that all measures were gathered from participants using
self-report questionnaires. This may result in over or underre-
porting of negative life events and somatic symptomatology.
On the other hand, self-report measures may be the most ap-
propriate instruments for the hypotheses considered in this
study. Furthermore, as this study uses a convenience sample, it
remains to be seen whether the findings can be generalised to
more representative sample of adolescent’s. Additional pro-
spective studies should seek to use random and diverse sample
to make generalisation possible, and also include more objec-
tive measures such as recorded sick days and actual usage of
health services in the assessment of the individual’s health. In
addition, studies using lager samples than mine should be un-
A strength of this study compared to most previous studies of
the effect of optimism on adolescents health, is the use of a
prospective design that make it possible to infer the likelihood
of causal relationships between the study variables. However, it
should be noted that despite the significant advantages that are
associated with using a longitudinal design, findings from the
present study do not in themselves provide conclusive evidence
of causal linkages between optimism and later somatic symp-
toms (see Pedhazur, 1982). The use of experimental designs
would be appropriate in investigating such potential connec-
Arbuckle, J. L., & Wothke, W. (1999). AMOS 4.0 user’s guide. Chi-
Aro, H. (1987). Life stress and psychosomatic symptoms among 14 to
16 years old Finnish adolescents. Psychological Medicine, 17, 191-
Aromaa, M., Sillanpaa, M., Rautava, P., & Helenius, H. (2000). Pain
experience of children with headache and their families: A controlled
study. Pediatrics, 106, 270-275. doi:10.1542/peds.106.2.270
Aspinwall, L. G., & Taylor, S. E. (1992). Modelling cognitive adaption:
A longitudinal investigation of the impact of individual differences
and coping on college adjustment and performance. Journal of Per-
sonality and Social Psychology, 63, 989-1003.
Boey, C. C. M., & Goh, K.-L. (2001). The significance of life-events as
contributing factors in childhood recurrent abdominal pain in urban
community in Malaysia. Journal of Psychosomatic Research, 51,
Brisette, I., Scheier, M. F., & Carver, C. S. (2002). The role of opti-
mism in social network development, coping, and psychological ad-
justment during a life transition. Journal of Personality and Social
Psychology, 82, 102-111. doi:10.1037/0022-3518.104.22.168
Campo, J. V., & Fritsch, S. L. (1994). Somatization in children and
adolescents. Journal of American Academy of Child and Adolescent
Psychiatry, 33, 1223- 1235. doi:10.1097/00004583-199411000-00003
Chang, E. C. (1998b). Does dispositional optimism moderate the rela-
tion between perceived stress and psychological well-being?: A pre-
liminary investigation. Personality and Individual Differences, 25,
Chang, E. C., & Sanna, L. J. (2003). Experience of life hassles and
psychological adjustment among adolescents: Does it make a differ-
ence if one is optimistic or pessimistic? Personality and Individual
Differences, 34, 867-879. doi:10.1016/S0191-8869(02)00077-6
Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi,
L. (1974). The Hopkins Symptom Checklist (HSCL). A measure of
primary symptom dimensions. Modern Problems of Pharmacopsy-
chiatry, 7, 79-110.
Dhossche, D., Ferdinand, R., van der Ende, J., & Verhulst, F. (2001).
Outcome of self-reported functional somatic symptoms in a commu-
nity sample of adolescents. Annals of Clinical Psychiatry, 13, 191-
Di Lorenzo, C., Coletti, R. B., Lehmann, H. P., Boyle, J. T., Gerson, W.
T., Hyams, J. S., Squires, R. H. Jr., Walker, L. S., & Kanda, P. T.
(2005). Chronic abdominal pain in children: A clinical report of the
American academy of pediatrics and the North American society for
pediatric gastroenterology, hepatology and nutrition. Journal of Pe-
diatric Gastroenterology and Nutrition, 40, 245-248.
Egger, H. L., Costello, E. J., Erkanli, A., & Angold, A. (1999). Somatic
complaints and psychopathology in children and adolescents: Stom-
ach aches, musculoskeletal pains, and headaches. Journal of the
American Academy of Child and Adolescent Psychiatry, 38, 852-860.
Garber, J., Walker, L., & Zeman, L. (1991). Somatization symptoms in
a community sample of children and adolescents: Further validation
of the children’s somatization inventory. Psychological Assessment:
A Journal of Consulting and Clinical Psychology, 3, 588-593.
Copyright © 2012 SciRes.
T. A. MURBERG
Copyright © 2012 SciRes. 127
Haug, T. T., Mykletun, A., & Dahl, A. A. (2004). The association be-
tween anxiety, depression, and somatic symptoms in a large popula-
tion: The HUNT-II study. Psychosomatic Medicine, 66, 845-851.
Lai, J. C. L. (2009). Dispositional optimism buffers the impact of daily
hassles on mental health in Chinese adolescents. Personality and In-
dividual Differences, 47, 247-249. doi:10.1016/j.paid.2009.03.007
Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New
Mäkikangas, A., & Kinnunen, U. (2003). Psychosocial work stressors
and well-being: Self esteem and optimism as moderators in a one-
year longitudinal sample. Personality and Individual Differences, 35,
Mosing, M. A., Pedersen, N. L., Martin, N. G., & Wright, M. J. (2010).
Sex differences in the genetic architecture of optimism and health
and their intercorrelation: A study of Australian and Swedish twins.
Twin Research and Human Genetics, 13, 322-329.
Mulvaney, S., Lambert, E. W., Garber, J., & Walker, L. S. (2006).
Trajectories of symptoms and impairment for pediatric patients with
functional abdominal pain: A 5-year longitudinal study. Journal of
the American Academy of Child & Adolescent Psychiatry, 45, 737-
Murberg, T. A., & Bru, E. (2009). The relationships between negative
life events, perceived support in the school environment and depres-
sive symptoms among Norwegian senior high school students: A
prospective study. Social Psychology of Education, 12, 361-370.
Norusis, M. J. (2008). SPSS 16.0 guide to data analysis. Englewood
Cliffs, NJ: Prentice Hall.
Pedhazur, E. J. (1982). Multiple regressions in behavioral research
(2nd ed.). New York: Holt, Rinehart & Winston.
Ryan-Wenger, N. M. (1994). Pychogenic pain in children. Annual
Review of Nursing Research, 12, 3-31.
Scheier, M. F., & Carver, C. S. (1985). Optimism, coping and health:
Assessment and implications of generalised outcome expectancies.
Health Psychology, 4, 219-247.
Scheier, M. F., & Carver, C. S. (1992). Effects of optimism on psycho-
logical and physical well-being: Theoretical overview and empirical
update. Cognitive Therapy and Research, 16, 201-228.
Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Optimism,
pessimism, and psychological well-being. In E. C. Chang (Ed.), Op-
timism and pessimism: Implications for theory, research, and prac-
tice (pp. 189-216). Washington DC: American Psychological Asso-
Skodol, A. E. (1998). Personality and coping as stress-attenuating or
amplifying factors. In B. P. Dohrenwend (Ed.), Adversity, stress, and
psychopathology (pp. 187-203). New York: Oxford Univer sity Press.
Swearingen, E. M., & Cohen, L. H. (1985b). Measurement of adoles-
cents’ life events: The junior high life experiences survey. American
Journal of Community Psychology, 16, 204-211.
Taylor, S. E., Kemeny, M. E. , Bower, J. E., Gruenewald, T. L. , & Ree d ,
G. M. (2000). Psychlogical resources, positive illusions, and health.
American Psychologist, 55, 99-109.
Ursin, H., Endresen, I. M., & Ursin, G. (1988). Psychological factors
and self-reports of muscle pain. European Journal of Applied Physi-
ology and Occupational Physiology, 57, 282-290.
Waaktaar, T., Borge, A. I. H., Fundingsrud, H. P., Christie, H. J., &
Torgersen, S. (2004). The role of stressful life events in the devel-
opment of depressive symptoms in adolescence: A longitudinal
community study. Journal of Adolescence, 27, 153-163.
Wagner, B. M., & Compas, B. E. (1990). Gender, instrumentality, and
expressivities: Moderators of the relation between stress and psy-
chological symptoms during adolescence. American Journal of
Community Psychology, 18, 383-406. doi:10.1007/BF00938114
Walker, L. S., Garber, J., & Greene, J. W. (1994). Somatic complaints
in pediatric patients: A prospective study of the role of negative life
events, child social academic competence, and parental somatic
symptoms. Journal of Consulting & Clinical Psychology, 62, 1213-
Winokur, M., Winokur, D., Rickels, K., & Cox, D. S. (1984). Symp-
toms of emotional distress in family planning services: Stability over
four-week period. British Journal of Psychiatry, 144, 395-399.
Ystgaard, M. (1997). Life stress, social support and psychological dis-
tress in late adolescence. Social Psychiatry and Psychiatric Epidemi-
ology, 32, 277-283. doi:10.1007/BF00789040
Ystgaard, M., Tambs, K., & Dalgard, O. S. (1999). Life stress, social
support and psychological distress in late adolescence: A longitudi-
nal study. Social Psychiatry & Psychiatric Epidemiology, 34, 12.