Abstract
Background
During pandemics, implementing Public Health and Social Measures (PHSM) by governments and compliance with PHSM by individuals is paramount. However, adolescents have been less compliant in performing COVID-19 preventive behaviors, and PHSM have been associated with deterioration of adolescent mental health.
Objective
The study aims to explore perceived difficulties in compliance with COVID-19 PHSM and their associations with adolescent mental health (perceived stress, psychosomatic complaints, and general self-efficacy) in Bulgaria.
Method
A cross-sectional nationally representative school-based survey of early to middle adolescents was conducted in 2022/2023 (N = 3326, mean age—14.0 years, 49.2% girls). Methods comprised the Perceived Difficulties in Compliance with COVID-19 Public Health Measures Scale, Cohen Perceived Stress Scale—4, Psychosomatic Complaints Scale, and General Self-Efficacy—short scale.
Results
Adolescents differentiated between Health Measures and Social Measures, both being more difficult for younger adolescents. Social Measures were more difficult for girls and the general sample. Perceived difficulty of Health Measures was expectedly associated with worse adolescent mental health, while perceived difficulty of Social Measures was associated with greater psychosomatic complaints but lower perceived stress and higher self-efficacy (adjusted for experienced quarantine/self-isolation, adolescent or family member COVID-19 infection, gender, and age).
Conclusions
The findings have implications for increasing preparedness for future pandemics of health experts and health, school, and social systems, as well as parents, youth, and society members. Adolescents’ specific perceived difficulties and needs to maintain significant social bonds should be addressed to facilitate understanding and compliance with PHSM, while ensuring adolescents’ psychosocial development and maintaining their mental health.