| Summary: | Abstract Background Adolescents are reporting increasing symptoms of anxiety, depression and somatization and an increase in perceived stress is a plausible explanation. The first aim of this study was to examine the occurrence of perceived stress and health outcomes in adolescents, and to evaluate if there are any sex differences. The second aim was to investigate if there is an association between perceived stress and the health outcomes and, if so, possible gender differences in this association. The third aim was to compare samples of adolescent girls and boys from two different European countries to enhance the generalizability of potential findings. Methods The sample included 636 students from Sweden and Bulgaria, aged 15–16, 164 (58% males, 41% females, 1% not specified) from Sweden and 472 (71% males, 28% females, 1% not specified) from Bulgaria. Perceived stress and health outcomes were measured by the 14-item “Perceived Stress Scale” (PSS-14), and a shorter version of the questionnaire "Children and Young People in Skåne" (Folkhälsoenkäten, FHE), respectively. T-test and Chi2 and/or Fisher’s exact test was used to compare results between boys and girls from the PSS-14 and health outcomes. The association between PSS and the health outcomes was assessed using Spearman’s rank correlation and comparisons between boys and girls were calculated using linear regression. Results There were significant associations between perceived stress and psychiatric symptoms in all groups. Adolescent girls in both Sweden and Bulgaria consistently reported higher levels of perceived stress and more psychiatric and somatic symptoms than the boys. Conclusions Evaluating methods for lessening the perception of stress, and their clinical presentation, should be considered in order to reduce the occurrence of psychiatric symptoms in adolescents.
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