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Trends in mental health problems among Swedish adolescents: Do school-related factors play a role?
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.ORCID iD: 0000-0003-1315-9603
Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Center for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden;Department of Neuroscience, Uppsala University, Uppsala, Sweden.ORCID iD: 0000-0002-8853-2508
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
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2024 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 19, no 3, p. e0300294-e0300294Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study is to investigate the extent to which school-related factors, such as school liking, participation in decision-making, school-related parental support, teachers’ support, and school physical environment, explain trends in mental health problems. The problems considered are psychosomatic symptoms (PSS), depressive symptoms (DS), suicidal ideations (SI), and suicide attempts (SA) among Swedish adolescents of varying socioeconomic status (SES) from 2004 to 2020.

Methods: We analyzed data collected through repeated cross-sectional surveys from 19,873 15-year-old students at schools in a county in Sweden. Boys and girls each constituted 50% of the participants. We fitted linear and logistic regression models to investigate associations between school-related factors and trends in mental health problems.

Results: Increased school-related parental support and school liking were cross-sectionally associated with decreased PSS, DS, and SI, with school liking also associated with decreased SA. A conducive school physical environment was also found to be cross-sectionally associated with lower PSS and DS scores. Over time, mental health problems have shown a general increase among adolescents in the low SES group and a decrease among those in the high SES group. While school-related factors explained the improvement in mental health in the high SES group, we found such an association only between parental support trends in PSS and DS, along with participation and trends in SA over time among adolescents in the low SES group.

Conclusions: The results show that school-related factors play significant roles in influencing adolescent mental health. The influence, however, varied across SES gradients over time. This suggests that working against inequities in school-related factors would help address inequities in mental health.

Place, publisher, year, edition, pages
2024. Vol. 19, no 3, p. e0300294-e0300294
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:mdh:diva-66219DOI: 10.1371/journal.pone.0300294ISI: 001181701200063PubMedID: 38457463Scopus ID: 2-s2.0-85187514377OAI: oai:DiVA.org:mdh-66219DiVA, id: diva2:1843418
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-00492Available from: 2024-03-11 Created: 2024-03-11 Last updated: 2024-05-16Bibliographically approved
In thesis
1. Mental health problems among adolescents in Sweden: Analysis of trends, developmental trajectories, and associated factors
Open this publication in new window or tab >>Mental health problems among adolescents in Sweden: Analysis of trends, developmental trajectories, and associated factors
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Västerås, Sweden: Mälardalens universitet, 2024
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 411
Keywords
Adolescent, mental health problems, trends, trajectories, Social Determinants of Health
National Category
Medical and Health Sciences
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:mdh:diva-66623 (URN)978-91-7485-652-1 (ISBN)
Public defence
2024-09-06, Lambda och digitalt via Zoom, Mälardalens universitet, Västerås, 13:15 (English)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-00492
Available from: 2024-05-20 Created: 2024-05-16 Last updated: 2024-08-16Bibliographically approved

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Buli, Benti GeletaNilsson, Kent W.Hellström-Olsson, CharlottaGiannotta, Fabrizia

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