Exposure to multifaceted violence and subjective health complaints in adolescents: the remit of school health services, a cross-sectional study in Sweden.

Introduction: Despite free student health services in Sweden, subjective health complaints (SHC) and violence remain common among adolescents. Evidence on how different forms of violence relate to these symptoms is limited. This study examined associations between multifaceted violence and SHC among adolescents by sex and sexual orientation. Methods: A cross-sectional digital survey (2024) was conducted among first-year upper-secondary students in a sparsely populated county of Sweden, covering approximately one-tenth of the national land area (n=668; 76%). SHCs measured using the Health Behaviour in School-aged Children symptom checklist. past-year victimisation (physical, psychological and sexual), childhood witnessing of violence and perpetration were assessed using items adapted from the Sexual health Identification Tool. Demographic variables included sex, place of birth and sexual orientation. Descriptive statistics and sex-stratified hierarchical regression analyses were conducted. Results: Overall, 15.3% reported past-year violence exposure, more commonly among girls than boys (17.1% vs 12.4%, p<0.001). Boys more often reported repeated physical victimisation and physical perpetration, whereas girls more frequently reported psychological victimisation and witnessing psychological violence during childhood. Non-heterosexual adolescents reported higher violence exposure scores and higher levels of several SHC compared with heterosexual peers. In sex-stratified regression analyses, experienced violence was independently associated with higher SHC scores among both girls (β=0.245, p<0.001) and boys (β=0.175, p=0.004). Witnessed violence during childhood was also independently associated with higher SHC among girls (β=0.245, p<0.001) and boys (β=0.133, p=0.029). Sexual orientation remained independently associated with higher SHC only among boys (β=0.220, p<0.001). Conclusions: Violence exposure patterns differed by sex, while sexual-minority adolescents reported greater violence exposure and symptom burden. Both experienced and witnessed childhood violence were independently associated with higher SHC, indicating that violence-related health consequences extend beyond direct victimisation. Further research and prevention efforts should better recognise diverse violence experiences, including boys who are often primarily framed as perpetrators rather than victims and sexual-minority youth.