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The overall aim of this thesis was to investigate trends and trajectories of mental health problems and associated factors among adolescents in Sweden. The project consisted of four studies, with the first presenting trends and the subsequent ones exploring influencing factors. The first two studies used data from SALVe, repeated cross-sectional surveys from 2004 – 2020, while the third used national HBSC data from 2002 – 2018. Study IV was based on data from SALVe cohorts conducted among young people born in 1997 and 1999 where data were collected in four waves every three years from 2012 – 2021.   

Study I investigated trends in mental health problems among adolescents in Västmanland County, revealing an overall decrease but disparities based on socioeconomic status (SES) and sex. Higher SES was associated with reduced mental health problems, while lower SES showed an increase. Girls exhibited a more pronounced decrease in depressive symptoms and suicidal ideations than boys. Study II, using the same dataset, confirmed these trends and identified school-related factors influencing mental health problems, with improvements correlating with reduced problems in the high SES group. Study III found a significant increase in PSS over time, higher in girls, and linked to lifestyle factors, particularly alcohol drunkenness among high SES adolescents. Study IV focused on cohorts born in 1997 and 1999, exploring the impact of family and peer relationships on depressive and anxiety symptoms among young people.

The results indicate that intermediary factors, including school-related factors, lifestyle choices, and social relationships, which vary across SES gradients, are linked to adolescent mental health problems. The associations between these intermediary factors and the mental health problems were, in most cases, influenced by a group of factors, including SES, sex, country of origin, and birth cohort, collectively named structural determinants. These determinants discriminated results between boys and girls, high SES and low SES, Nordic and non-Nordic origin, and the 1997 and 1999 cohorts. This underscores the need for at least two-tiered policy intervention. The first involves an immediate to mid-term response, targeting these intermediary factors with a special focus on the low SES group, girls, and young people with foreign backgrounds. The second entails a long-term policy intervention to narrow the divide.