Perceived parental alcohol problems and drinking patterns among adolescents in Sweden

Introduction

Much research into the links between parental problematic alcohol use and adolescent substance use has focused on clinically diagnosed parental alcohol disorders. Few prior studies have utilised validated measures of adolescents' perception of parental alcohol problems and considered the severity of these problems. This study examined the associations between the severity of perceived parental alcohol problems and adolescents' drinking patterns in a Swedish national sample.

Methods

We used survey information from grade 9 and 11 students (15-18 years) from 2021 (n = 9,227). Perceived parental alcohol problems were measured by the short version of The Children of Alcoholics Screening Test (CAST-6). The outcomes were: alcohol consumption during the past 12 months, frequent heavy episodic drinking (HED), and early alcohol debut (before age 14). Sociodemographic characteristics were adjusted for.

Results

Binary logistic regressions showed that the severity of perceived parental alcohol problems was associated with alcohol consumption during the past 12 months (low severity OR 1.53, p < 0.001; moderate severity OR 1.85, p < 0.001; high severity OR 2.52, p < 0.001), HED (low severity OR 1.16, n.s.; moderate severity OR 1.31, n.s.; high severity OR 1.64, p < 0.01), and early alcohol debut (low severity OR 1.57, p < 0.001; moderate severity OR 1.65, p < 0.001; high severity OR 2.20, p < 0.001).

Conclusions

Adolescents with perceived parental alcohol problems are more likely to have risky drinking patterns themselves, and the likelihood becomes higher with increased severity. Effective interventions for children whose parents have drinking problems are important, and should also take the severity of the parents' drinking problem into account.

Loneliness, belonging and psychosomatic complaints across late adolescence and young adulthood: a Swedish cohort study

BACKGROUND

Loneliness and belonging refer to social connectedness and are associated with young people's health; however, the relationship between these constructs and their impact on health is still being discussed. A dual continuum model of belonging and loneliness has been suggested, consisting of four groups depending on the state of loneliness and belonging: socially fulfilled (low loneliness, high belonging), socially indifferent (low loneliness, low belonging), socially searching (high loneliness, high belonging), and socially distressed (high loneliness, low belonging). The aim of this study is to examine loneliness and belonging in a Swedish sample of 17-18-years-olds who were followed over 3 years, and the associations that these aspects share with young people's psychosomatic complaints during these ages.

METHODS

Swedish cohort data collected among late adolescents (age 17-18 in 2019) who were followed up in young adulthood (age 20-21 in 2022) (n = 2684) was used to examine the associations between loneliness, belonging, and psychosomatic complaints. Loneliness and belonging were measured by single items and the cross-combinations of these. Three psychosomatic complaints were assessed: stomach ache, headache, and difficulties falling asleep, and a summary index was calculated.

RESULTS

Linear regression analyses showed that loneliness was positively and belonging was negatively cross-sectionally associated with psychosomatic complaints. The socially fulfilled group reported fewer psychosomatic complaints compared to all other groups, while the socially distressed group reported the highest level of psychosomatic complaints. Additional adjustment for sociodemographic characteristics barely affected the estimates. The prospective analysis supported these patterns; however, after adjustment for earlier psychosomatic complaints, the only statistically significant difference in subsequent psychosomatic complaints was found between the socially fulfilled and the socially distressed groups.

CONCLUSIONS

Loneliness and belonging (separately and the cross-combinations of these) were cross-sectionally associated with psychosomatic complaints in late adolescence and in young adulthood. Prospectively, only the most vulnerable group in the dual continuum model, the socially distressed group, experienced more psychosomatic complaints than the socially fulfilled group, indicating a temporal relationship. Knowledge about the more nuanced links may be useful for developing specific public health recommendations and interventions for youth, targeting the most vulnerable groups.

Bullying experiences before and after the transition from lower to upper secondary school: associations with subsequent mental health in a Swedish cohort

BACKGROUND

Previous research has shown that exposure to bullying is linked to long-term adverse mental health consequences. However, prospective studies examining the persistence of bullying, using information from repeated time points, are limited. The aim of this study was to examine, firstly, the extent to which exposure to bullying among adolescents in Sweden changes between grades 9 (age 15-16) and 11 (age 17-18) (i.e., before and after the transition from lower to upper secondary school); secondly, whether being bullied in grade 9 or 11 is associated with depression and anxiety symptoms at age 20-21; and thirdly, if being bullied in both grade 9 and 11 is linked to an even higher likelihood of subsequent depression and anxiety symptoms. Potential differences by gender were investigated throughout.

METHODS

Data was derived from the Swedish cohort study Futura01 involving individuals attending grade 9 in the school year 2016/17 (n = 2323). We utilised self-reported information from three survey waves conducted in 2017, 2019, and 2022, and linked registry information on sociodemographic characteristics. Bullying was assessed using a single item in waves 1 and 2. Depression and anxiety symptoms were measured using the Patient Health Questionnaire-4 (PHQ-4) in wave 3. Gender stratified binary logistic regressions were performed.

RESULTS

Among those who were bullied in grade 9, 22.6% of males and 35.8% of females continued to experience bullying in grade 11. For females, exposure to bullying in grade 9 or 11 was associated with an increased likelihood of reporting depression and anxiety symptoms at age 20-21, with the highest odds for those bullied at both time points. For males, only one statistically significant association was identified - specifically, between being bullied in grade 9 and subsequent depression symptoms.

CONCLUSIONS

For a majority of adolescents who experience bullying in lower secondary school, but not all, the transition to upper secondary school proves to be beneficial as the bullying typically does not persist. However, bullying can have long-term health effects, in particular for females. These findings emphasise the importance of effective measures to address bullying within schools.

Trust in adolescence and depression and anxiety symptoms in young adulthood: findings from a Swedish cohort

OBJECTIVE

Trust and health are both fundamental elements of a socially sustainable society. While much research has shown that trust is associated with better mental health outcomes in adults, studies of young people are relatively scarce, despite the fact that mental health problems are common in young ages. In particular, there are few longitudinal studies that cover different dimensions of trust. Building on a previous study on trust and psychosomatic complaints in adolescents, the aim was to examine the links between generalised and institutional trust in adolescence and depression and anxiety symptoms in young adulthood. Data was obtained from a Swedish cohort study with self-reported information on generalised and institutional trust at ages 15-16 and 17-18 and depression and anxiety symptoms at age 20-21 (n = 2,668). Covariates included sociodemographic characteristics and indicators of prior mental health status.

RESULTS

Binary logistic and linear regressions showed that higher levels of generalised trust at ages 15-16 and 17-18 were inversely associated with depression and anxiety symptoms at age 20-21. Institutional trust was however not linked with subsequent depression and anxiety symptoms when adjusting for generalised trust and covariates. The findings indicate that generalised trust is a social determinant for mental health in young people.

Parenting Practices and Psychosomatic Complaints Among Swedish Adolescents

Objectives: Parent-adolescent relationships play a crucial role in youth development. This study examines the associations between parenting practices (parental support, knowledge, and rule-setting) and psychosomatic complaints across middle and late adolescence. Methods: The study utilised data from a Swedish national cohort (n = 3,678). Participants completed self-report questionnaires in 2017 (∼15-16 years) and again in 2019 (∼17-18 years). Results: Parental support exhibited the strongest and most consistent inverse cross-sectional associations with psychosomatic complaints during both middle and late adolescence. Furthermore, increases in parental support and parental knowledge were associated with decreases in adolescent psychosomatic complaints. However, parental support and knowledge at age 15-16 were not prospectively associated with psychosomatic complaints at age 17-18. Conclusion: These findings underscore the importance of ongoing parental engagement, particularly in terms of providing constant support, throughout middle and late adolescence.

Prospective associations between psychosomatic complaints in adolescence and depression and anxiety symptoms in young adulthood: A Swedish national cohort study

Background

Psychosomatic complaints are reported by high shares of adolescents in Sweden and elsewhere. Yet, little is known about to the extent to which the frequency, number, and persistence of such complaints in adolescence are associated with subsequent mental health problems. The aim of this study was to examine how the frequency, number, and persistence of psychosomatic complaints in middle and late adolescence are associated with depression and anxiety symptoms in young adulthood.

Methods

A Swedish national cohort study of adolescents who were surveyed in 2017 (t1; age 15-16), in 2019 (t2; age 17-18) and in 2022 (t3; age 20-21 years) was used. Psychosomatic complaints were measured by questions on stomach ache, headache and difficulties falling asleep at t1 and t2. Depression and anxiety symptoms were measured by the Patient Health Questionnaire-4 (PHQ-4) at t3. Multivariable binary logistic regression analyses stratified by gender were based on data from t1, t2 and t3 (n = 2779).

Results

The frequency, number, and persistence of psychosomatic complaints during adolescence were associated with symptoms of depression and anxiety in young adulthood. Both earlier (at t1 only) and more recent (at t2 only) complaints were linked to subsequent depression and anxiety symptoms, while persistent (at both t1 and t2) psychosomatic complaints showed stronger associations in girls.

Conclusions

Psychosomatic complaints in adolescence were associated with depression and anxiety symptoms in young adulthood. This was true for the frequency, number, and persistence of psychosomatic complaints. Among girls, those who reported persistent psychosomatic complaints from middle to late adolescence had the highest likelihood of reporting subsequent depression and anxiety symptoms. Taken together, the results indicate that psychosomatic complaints during adolescence can translate into later depression and anxiety symptoms. Furthermore, repeated measurements of psychosomatic complaints can be used to identify the most vulnerable group.

Problematic familial alcohol use and adolescent outcomes: Do associations differ by parental education?

Aim: To investigate the associations between problematic familial alcohol use and adolescent subjective health, binge drinking, relationships with parents, school performance, and future orientation, and to study whether these associations differ in relation to parental education. Methods: Cross-sectional data from the Stockholm School Survey (SSS) collected among students in the 9th and 11th grades in 2018 and in 2020 were used (n = 19,415). Subjective health, parent-youth relationships, and school performance were coded as continuous variables; binge drinking and future orientation were coded as binary variables. Familial drinking included three categories: problematic; don't know/missing; and not problematic. Parental university education distinguished between adolescents with two, one, or no university-educated parent(s). Control variables included gender, grade, family structure, migration background, parental unemployment, and survey year. Linear and binary logistic regression analyses were performed. Results: Problematic familial alcohol use was associated with worsened subjective health, a higher likelihood of engaging in binge drinking, worse relationships with parents, and a higher likelihood of having a pessimistic future orientation, even when adjusting for all control variables. Having less than two university-educated parents was associated with a higher likelihood of reporting problematic familial alcohol use. Parental university education moderated the association between problematic familial alcohol use and binge drinking as this relationship was stronger for adolescents with no and one university-educated parent(s). Conclusions: Adolescents with problematic familial alcohol use fared worse with regards to all studied outcomes, except for school performance. Parental university education only moderated the association between problematic familial alcohol use and binge drinking. However, since problematic familial alcohol use was more common among adolescents with less than two university-educated parents, we argue that at the group level, this category may be more negatively affected by alcohol abuse in the family. Policy interventions could benefit from having a socioeconomic perspective on how children are affected by alcohol's harms to others.

Trust and Psychosomatic Complaints in Adolescence: Findings From a Swedish Cohort Study

Objectives: To examine the cross-sectional and longitudinal associations between generalised and institutional trust and psychosomatic complaints in mid and late adolescence. Methods: Data were derived from the Swedish cohort study Futura01, using survey information collected amongst 3,691 grade 9 students (∼15-16 years, t1) who were followed-up 2 years later (∼17-18 years, t2). Registry information on sociodemographic characteristics was linked to the data. Linear regression analyses were performed. The longitudinal analyses applied the first difference (FD) approach as well as the lagged dependent variable (LDV) approach. Covariates included gender, family type, parental education, parental country of birth, and upper secondary programme. Results: Higher levels of generalised and institutional trust were cross-sectionally associated with lower levels of psychosomatic complaints at both time points. The FD analyses showed that increases in generalised and in institutional trust between ages 15-16 and 17-18 years were associated with corresponding decreases in psychosomatic complaints. The LDV analyses demonstrated reciprocal temporal associations between trust and psychosomatic complaints. Conclusion: The findings indicate that trust is a social determinant of psychosomatic complaints in adolescents, but also that health may affect trust.

Perceived problematic alcohol use in the family and adolescents' stress-related complaints: examining the buffering role of the school's degree of student focus as rated by its teachers

BACKGROUND

A non-negligible proportion of children grow up with problematic alcohol use in the family. Problematic familial drinking can be regarded as a stressor, and prior studies have consistently reported poorer mental health among adolescents who are exposed. However, it is also of relevance to identify modifiable protective factors which may buffer against stress-related ill-health in this group of adolescents. One context where such factors may be present is the school. The aim of this study is to examine the relationship between perceived problematic familial alcohol use and students' stress-related complaints, and specifically to explore if the school's degree of student focus can buffer against any such negative health consequences of problem drinking at home.

METHODS

Data were drawn from four separate surveys, the Stockholm School Survey (SSS) and the Stockholm Teacher Survey (STS) conducted in 2014 and 2016 among 7,944 students (~ 15-16 years) and 2,024 teachers in 147 Stockholm senior-level school units. Perceived problematic familial alcohol use was measured by one item in the SSS. Stress-related complaints were captured by co-occurring somatic complaints and psychological distress, and reported by students in the SSS. The school's student focus was measured by an index based on teachers' ratings of four items in the STS. A set of covariates at the student and the school level were also included. Two-level binary logistic and linear regression models were performed.

RESULTS

Perceived problematic familial alcohol use was linked with an increased likelihood of reporting co-occurring somatic complaints as well as psychological distress. Cross-level interactions revealed that the association between perceived problematic familial alcohol use and co-occurring somatic complaints was weaker among students attending schools with stronger teacher-rated student focus. Regarding psychological distress, the association was weaker for students attending schools with intermediate or strong teacher-rated student focus, compared with those attending schools with weaker teacher-rated student focus.

CONCLUSIONS

The findings provide support for the assumption that favourable conditions in schools can buffer against negative health consequences of problematic conditions in the family, thus serving a compensatory role.

School collective efficacy and gambling: A multilevel study of 11th grade students in Stockholm

The aim of the present study was to investigate variations between schools when it comes to gambling and risk gambling, and, in particular, to analyse the links between school collective efficacy and student gambling and risk gambling. The data consists of official register information on schools as well as survey data collected in 2016 among 1,061 teachers and 5,191 students in 46 Stockholm upper secondary schools. School collective efficacy was operationalized on the basis of teacher responses, which were aggregated to the school level. Gambling and risk gambling were based on students' self-reports. Two-level binary logistic regression analyses were performed. The results show that there is between-school variation in gambling and in all the study's indicators of risk gambling. Both gambling and risk gambling were more commonly reported by students attending schools with weak collective efficacy, even when adjusting for student- and school-level sociodemographic characteristics. The findings suggest that conditions at school may counteract students' engagement in gambling and risk gambling.

Perceived parental alcohol problems and psychosomatic complaints among adolescents in Sweden

Introduction

For adolescents, parental problem drinking can be regarded as a chronic stressor, negatively affecting their health. There is limited knowledge and a relative lack of empirical evidence on this topic, especially in Sweden. The aim of the current study was to examine perceived parental alcohol problems and the links with psychosomatic complaints among adolescents in Sweden.

Methods

Data were obtained from the Swedish Council for Information on Alcohol and Other Drugs' national survey of 2021, collected amongst 9,032 students in grades 9 (∼15-16 years) and 11 (∼17-18 years). Perceived parental alcohol problems were measured by the Children of Alcoholics Screening Test (CAST-6) scale, using a cutoff at ≥ 3. Psychosomatic complaints were captured by a binary measure based on the frequency of headache, stomach ache, feeling depressed or down, difficulties to fall asleep, and sleeping poorly at night. Sociodemographic characteristics included gender, grade, parental education, and parental country of birth. Descriptive analyses with chi2 tests and binary logistic regression analyses were performed.

Results

Adolescents with perceived parental alcohol problems had higher odds of reporting psychosomatic complaints compared with adolescents without perceived parental drinking problems, even when adjusting for sociodemographic characteristics. Girls, grade 11 students, adolescent with at least one parent born in Sweden, and those without university-educated parents were more likely to report parental alcohol problems.

Conclusions

The findings highlight adolescents with perceived parental alcohol problems need support. The school, being an arena where adolescents spend much of their time, may play a vital role in this regard.

Psychosocial School Conditions and Mental Wellbeing Among Mid-adolescents: Findings From the 2017/18 Swedish HBSC Study

Objectives: To investigate mid-adolescent boys' and girls' experiences of school demands, teacher support, and classmate support, and explore the associations of these factors with mental wellbeing. Methods: Data were derived from the Swedish Health Behaviour in School-aged Children (HBSC) study of 2017/18, with information collected among 1,418 students in grade 9 (∼15-16 years). School demands, teacher support, and classmate support were measured by indices based on three items each. Mental wellbeing was measured by the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Linear regression analyses were performed. Results: Higher demands were associated with lower mental wellbeing. Conversely, mental wellbeing increased with greater teacher support and classmate support. Interactions between demands and the support variables showed that at the lowest levels of teacher and of classmate support, mental wellbeing was low and not associated with school demands. With increasing levels of teacher and classmate support, the overall level of mental wellbeing increased and revealed an inverse association between school demands and mental wellbeing. Conclusion: The study contributes with knowledge about how psychosocial conditions in school may hinder or enhance wellbeing among students.

Sources of perceived social support and emotional difficulties in late adolescence

Background

Late adolescence is a life phase when mental health problems are common. Social support is, however, associated with less problems. Social support stems from different sources with the family being the main provider in early life while friends gain in importance during adolescence. Using the Multidimensional Scale of Perceived Social Support (MSPSS), this study investigates the relative importance of different sources of support for emotional difficulties in girls and boys.

Methods

Data was derived from the Swedish population-based cohort study Futura01 (girls: n = 2105, boys: n = 1673). Adolescents in the final year in compulsory school (aged 15-16 years) were sampled in 2017 and followed up in 2019 (aged 17-18 years). Perceived social support was measured at 17-18 years by the MSPSS scale. Emotional difficulties were measured at 15-16 and 17-18 years by the Strengths and Difficulties Questionnaire (SDQ) subscale. Linear regression analysis was used to study associations between support sources and emotional difficulties at 17-18 years, adjusting for all support sources, family type, upper secondary school program as well as prior emotional difficulties.

Results

Among girls, emotional difficulties were associated with perceived support from family (b=-0.22; 95% CI -0.29; -0.15) and friends (b=-0.26; 95% CI -0.35; -0.18) but not significant others (b = 0.00; 95% CI -0.10; 0.11). Among boys, emotional difficulties were associated with support from family (b=-0.10; 95% CI -0.18; -0.02), friends (b=-0.17; 95% CI -0.25; -0.09) and significant others (b=-0.13; 95% CI -0.22; -0.04).

Conclusions

The negative association between perceived social support and emotional difficulties, irrespective of prior emotional difficulties, suggests that support has a protective effect. In late adolescence, support from friends and, to a similar degree, the family seems to matter for mental health. Support from significant others did however not show a protective effect in girls.

Key messages

• Adolescents aged 17-18 years with higher levels of perceived social support report less emotional difficulties.

• Efforts to increase family and friend support are relevant for adolescent mental health.

Self-reported strengths and difficulties among Swedish adolescents: presence, continuity and change

Background

The Strengths and Difficulties Questionnaire (SDQ) is a screening instrument for emotional and behavioural problems. Swedish reference values based on large-scale national data are lacking for mid- and late adolescents. Also, there is a scarcity of longitudinal studies about the development of strengths and difficulties from middle to late adolescence. The study aims were 1) to report on Swedish adolescents’ assessment of their strengths and difficulties and to present joint and gender-specific reference values for identifying risk groups; 2) to examine the continuity and change of strengths and difficulties and to what extent this differs by gender.

Methods

Data was based on a national Swedish sample of adolescents aged 15-16 years in 2017 (n = 5338) who were surveyed again in 2019 (n = 3973). Mean values and reference values for “close to average” (0th-80th percentile), “slightly raised” (&gt;80th-90th percentile) and “high” (&gt;90th percentile) SDQ scores were calculated. Comparison in SDQ scores by gender and across time was approached using inferential statistics.

Results

Girls reported higher levels of emotional problems (p = &lt;0.001), whereas boys showed higher levels of conduct problems (p = &lt;0.001) at t1 and t2. Hyperactivity slightly prevailed in girls (p = 0.007), and peer problems were slightly higher in boys (p = 0.027) at t2. Prosocial behaviour was higher in girls than boys (p = &lt;0.001) at t1 and t2. Changes in SDQ scores across time were in general small. Yet, analyses focusing on risk groups showed that among those who scored &gt;80th or &gt; 90th percentile at t1 about half scored above the same threshold at t2.

Conclusions

This study provided joint and gender-specific reference values for mid- and late adolescents in Sweden, and found some gender differences in SDQ scores and degree of change. Reported national gender-specific reference values may facilitate identifying adolescents at risk and potentially increasing timely mental health intervention measures.

Key messages

• Among the subscales indicating difficulties, the highest was level of emotional problems in girls and hyperactivity in boys; the largest increase over time was in emotional problems for both genders.

• Analyses of changes in SDQ mean scores showed only minor changes between t1 and t2, while analyses of movement between categories defined by cutoffs presented a more noticeable degree of change.

Sense of Unity and Self-Reported Health Among 15-year-Olds: Findings From the Swedish 2017/18 Health Behavior in School-Aged Children Study

Objectives: Sense of unity refers to the positive feeling of being part of a larger social structure. This study aimed to investigate to what extent adolescents report sense of unity and if this differs across groups, and to assess the associations between sense of unity and self-reported health while taking into account sociodemographic characteristics and tangible social relationships. Methods: Data were obtained from the 2017/18 Swedish Health Behavior in School-aged Children study, using information collected among 15-year-old students (n = 1,392). Linear and binary logistic regression analyses were performed. Results: The participants reported overall high levels of sense of unity. Sense of unity did not differ by gender, but adolescents without an immigrant background and those with higher family affluence reported higher levels. Sense of unity was inversely associated with psychological complaints, somatic complaints, and less than good self-rated health, even when adjusting for sociodemographic characteristics and family, classmate, and teacher relationships. Conclusion: This study suggests that sense of unity may be an important social determinant for adolescent health. More research is needed on the origins and implications of sense of unity.

Problematic familial alcohol use and heavy episodic drinking among upper secondary students: a moderator analysis of teacher-rated school ethos

Objective

Building on findings reported in a previous publication, the objective of this study is to explore if teacher-rated indicators of school ethos modify the association between problematic familial alcohol use and heavy episodic drinking among upper secondary students. Data were based on combined information from two separate surveys conducted in 2016 among 4709 students and 1061 teachers in 46 Stockholm upper secondary schools, with linked school-level information from administrative registers. Multilevel binary logistic regression analyses were performed.

Results

Problematic familial alcohol use was associated with an increased likelihood of heavy episodic drinking among upper secondary students (OR 1.36, 95% CI 1.12–1.65). Cross-level interactions revealed that the association was weaker among students attending schools with higher levels of teacher-rated ethos. This was true for overall school ethos (OR 0.79, 95% CI 0.65–0.97) and for four of five studied sub-dimensions of ethos: staff stability (OR 0.78, 95% CI 0.65–0.95); teacher morale (OR 0.79, 95% CI 0.65–0.97); student focus (OR 0.80, 95% CI 0.65–0.97); and academic atmosphere (OR 0.79, 95% CI 0.65–0.96). The sub-dimension “structure and order for dealing with unwanted behaviour” did however not moderate the association between problematic familial alcohol use and heavy episodic drinking (OR 0.95, 95% CI 0.77–1.18).

Sexual jokes at school and students' life satisfaction: findings from the 2017/18 Swedish Health Behaviour in School-aged Children study

OBJECTIVE

In a previous study we demonstrated that the occurrence of sexual jokes in the class was associated with higher levels of psychological health complaints. Building on and extending these findings, the aim of the current study was to examine if exposure to sexual jokes at the student and at the class level was inversely associated with students' life satisfaction. Data were derived from the 2017/18 Swedish Health Behaviour in School-aged Children (HBSC) study, with students aged 11, 13 and 15 years (n = 3710 distributed across 209 classes). Exposure to sexual jokes at the student level was captured by one item. Exposure to sexual jokes at the class level was calculated by aggregating this measure. The Cantril ladder was used to operationalise life satisfaction. Two-level logistic regression analyses were performed.

RESULTS

Students who were exposed to sexual jokes at school were less likely to report high life satisfaction (OR 0.38, 95% CI 0.27-0.53). An inverse association was found between the class proportion of students who were exposed to sexual jokes and students' likelihood of reporting high life satisfaction, whilst adjusting for exposure to sexual jokes at the student level (OR 0.98, 95% CI 0.97-0.9994). The findings highlight the importance of promoting a school climate without sexual harassment.

Classroom Immigrant Density Predicts Psychological Well-Being Among Adolescents With an Immigration Background: Findings From the 2017/18 Swedish Health Behaviour in School-Aged Children Study

Objectives: Group-level characteristics in shared contexts such as schools may affect adolescent psychological health. This study examined if the immigrant density in the classroom was associated with the level of self-reported psychological complaints among students with an immigration background.

Methods: Cross-sectional data were derived from 2,619 lower secondary school students (aged 13–15) in the 2017/18 wave of the Swedish Health Behaviour in School-aged Children (HBSC) survey. Using multilevel analysis estimating two-level random intercept linear regression models, classroom immigrant density was considered as a potential predictor of immigrant students’ psychological complaints.

Results: Students with an immigration background reported significantly fewer psychological complaints, on average, than students without such a background, even when adjusting for other sociodemographic characteristics. A cross-level interaction indicated that both first- and second-generation immigrant students experienced fewer psychological complaints in immigrant-dense classes compared to when the proportion of immigrant students was lower.

Conclusion: Students with an immigration background fare better psychologically in classes with a higher proportion of immigrant students. Such compositional effects could be alleviated by strengthening all schools’ capacities to provide a more inclusive classroom climate.

Internalising and externalising problems during adolescence and the subsequent likelihood of being Not in Employment, Education or Training (NEET) among males and females: The mediating role of school performance

Mental health problems are associated with a greater risk of being Not in Employment, Education or Training (NEET) during young adulthood. Yet evidence on the extent to which self-reported mental health problems precede males' and females’ NEET status and on the potential pathways linking mental health problems to NEET is lacking. This study examines the longitudinal associations that internalising and externalising problems during adolescence share with the risk of being NEET in young adulthood, with a focus on the mediating role of school performance. Data comes from a representative sample of 4,452 Swedish youth (51% females) who provided information on internalising and externalising problems at age 14–15 years. Information on secondary school grades (age 15–16 years), completion of upper secondary school (age 20–21 years) and NEET status at 21–22 years were drawn from administrative registers. Overall, 6% of participants were NEET at 21–22 years of age and rates were higher for those who had internalising and externalising problems at age 14–15 years. A series of gender-stratified multivariate regression models showed that for both genders, greater internalising and externalising problems predicted lower school grades and a reduced likelihood of upper secondary school completion. However, externalising problems were associated with an increased risk of being NEET for males, while internalising problems were associated with a higher likelihood of being NEET for females. The effects of externalising and internalising problems for males and females, respectively, were partially mediated by school performance. The findings indicate that mental health problems in adolescence are associated with exclusion from the labour market and education in early adulthood, but that internalising and externalising problems represent different risks for males and females. Furthermore, school performance in comprehensive and upper secondary school helps explain links between mental health problems and subsequent NEET status.

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Mental health problems in adolescence predicted NEET status in young adulthood.

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For females, the likelihood of being NEET was predicted by internalising problems.

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For males, the likelihood of being NEET was predicted by externalising problems.

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The associations were mediated by school performance.

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Mental health problems present risk for education and labour market exclusion.

Job strain and sense of coherence: Associations with stress-related outcomes among teachers

Background: Teachers constitute an occupational group experiencing high levels of stress and with high sick-leave rates. Therefore, examining potentially protective factors is important. While prior research has mainly focused on the link between teachers’ own experiences of their work environment and stress-related outcomes, it is also possible that colleagues’ perception of the work environment and their possibilities for dealing with work-related stress contribute to influencing individual teachers’ stress. Aim: The aim of this study was to investigate how teachers’ reports of high job strain (i.e. high demands and low control) and sense of coherence (SOC), as well as the concentration of colleagues reporting high strain and high SOC, were associated with perceived stress and depressed mood. Methods: The data were derived from the Stockholm Teacher Survey, with information from two cross-sectional web surveys performed in 2014 and in 2016 (N=2732 teachers in 205 school units). Two-level random intercept linear regression models were performed. Results: High job strain at the individual level was associated with higher levels of perceived stress and depressed mood, but less so for individuals with high SOC. Furthermore, a greater proportion of colleagues reporting high SOC was associated with lower levels of perceived stress and depressed mood at the individual level. Conclusions: High SOC may be protective against work-related stress among teachers. Additionally, the proportion of colleagues reporting high SOC was related to less individual stress, suggesting a protective effect of school-level collective SOC.

Poor family relationships in adolescence as a risk factor of in-patient somatic care across the life course: Findings from a 1953 cohort

Background

Prior research has shown that poor family relations during upbringing have long-term detrimental effects on mental health. Few previous studies have, however, focused on somatic health outcomes and studies rarely cover the life span until retirement age. The aims of the current study were, firstly, to examine the association between poor family relationships in adolescence and in-patient somatic care across the life course whilst adjusting for confounders at baseline and concurrent psychiatric in-patient care; and secondly, to compare the risks of somatic and psychiatric in-patient care across the life course.

Methods

Prospective data from the Stockholm Birth Cohort study were used, with 2636 participants born in 1953 who were followed up until 2016. Information on family relationships was collected from the participants’ mothers in 1968. Annual information on in-patient somatic and psychiatric care was retrieved from official register data from 1969 to 2016.

Results

Poisson regressions showed that poor family relationships in adolescence were associated with an increased risk of in-patient somatic care in mid- and especially in late adulthood (ages 44–53 and 54–63 years), even when controlling for the co-occurrence of psychiatric illness and a range of childhood conditions. No statistically significant association was observed in early adulthood (ages 16–43 years), when controlling for confounders. These findings are in sharp contrast to the analyses of inpatient psychiatric care, according to which the association with poor family relations was strongest in early adulthood and thereafter attenuated across the life course.

Conclusion

Poor family relationships in adolescence are associated with an increased risk of severe consequences for somatic health lasting to late adulthood even when controlling for confounders including in-patient psychiatric care, emphasising the potentially important role of early interventions.

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Using longitudinal data, the article investigates long term health consequences of poor family relationships in adolescence.

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We find an association between poor relations and increased risk of in-patient somatic care in mid- and in late adulthood.

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Conversely, the association between poor family relations and an in-patient psychiatric care is strongest in early adulthood.

Sexual jokes at school and psychological complaints: Student- and class-level associations

Background: Students who are subjected to sexual harassment at school report lower psychological well-being than those who are not exposed. Yet, it is possible that the occurrence of sexual harassment in the school class is also stressful for those who are not directly targeted, with potential negative effects on well-being for all students. Aim: The aim was to examine whether exposure to sexual jokes at the student level and at the class level was associated with students’ psychological complaints, and if these associations differed by gender. Method: Data from the Swedish Health Behaviour in School-aged Children (HBSC) of 2017/18 was used, with information from students aged 11, 13 and 15 years (N=3720 distributed across 209 classes). Psychological health complaints were constructed as an index based on four items. Exposure to sexual jokes at the student level was measured by one item, and at the class level as the class proportion of students exposed to sexual jokes, in per cent. Two-level linear regression analyses were performed.Results: Students who had been exposed to sexual jokes at school reported higher levels of psychological complaints, especially boys. Furthermore, the class proportion of students who had been exposed to sexual jokes was also associated with psychological complaints, even when adjusting for student-level exposure to sexual jokes, gender, grade and class size. Conclusions: Sexual jokes seem to be harmful for those who are directly exposed, but may also affect indirectly exposed students negatively. Thus, a school climate free from sexual jokes may profit all students.

Poor family relationships in adolescence as a risk factor of in-patient psychiatric care across the life course: A prospective cohort study

Background: Previous research has shown that poor family relations in childhood are associated with adverse mental health in adulthood. Yet, few studies have followed the offspring until late adulthood, and very few have had access to register-based data on hospitalisation due to psychiatric illness. The aim of this study was to examine the association between poor family relations in adolescence and the likelihood of in-patient psychiatric care across the life course up until age 55. Methods: Data were derived from the Stockholm Birth Cohort study, with information on 2638 individuals born in 1953. Information on family relations was based on interviews with the participants’ mothers in 1968. Information on in-patient psychiatric treatment was derived from administrative registers from 1969 to 2008. Binary logistic regression was used. Results: Poor family relations in adolescence were associated with an increased risk of later in-patient treatment for a psychiatric diagnosis, even when adjusting for other adverse conditions in childhood. Further analyses showed that poor family relations in adolescence were a statistically significant predictor of in-patient psychiatric care up until age 36–45, but that the strength of the association attenuated over time. Conclusions: Poor family relationships during upbringing can have serious negative mental-health consequences that persist into mid-adulthood. However, the effect of poor family relations seems to abate with age. The findings point to the importance of effective interventions in families experiencing poor relationships.

School ethos and adolescent gambling: a multilevel study of upper secondary schools in Stockholm, Sweden

Background

Gambling is not uncommon among adolescents, and a non-trivial minority has serious problems with gambling. Therefore, enhanced knowledge about factors that may prevent against problematic gambling among youth is needed. Prior research has shown that a strong school ethos, which can be defined as a set of attitudes and values pervading at a school, is associated with a lower inclination among students to engage in various risk behaviours. Knowledge about the link between school ethos and adolescent gambling is however scarce. The aim of the study was to investigate the association between teacher-rated school ethos and student-reported gambling and risk gambling, when controlling also for sociodemographic characteristics at the student- and the school-level.

Methods

Data from two separate cross-sectional surveys were combined. The Stockholm School Survey (SSS) was performed among 5123 students (aged 17–18 years) in 46 upper secondary schools, and the Stockholm Teacher Survey (STS) was carried out among 1061 teachers in the same schools. School ethos was measured by an index based on teachers’ ratings of 12 items in the STS. Adolescent gambling and risk gambling were based on a set of single items in the SSS. Sociodemographic characteristics at the student-level were measured by student-reported information from the SSS. Information on sociodemographic characteristics at the school-level was retrieved from administrative registers. The statistical method was multilevel regression analysis. Two-level binary logistic regression models were performed.

Results

The analyses showed that higher teacher ratings of the school’s ethos were associated with a lower likelihood of gambling and risk gambling among students, when adjusting also for student- and school-level sociodemographic characteristics.

Conclusions

This study showed that school ethos was inversely associated with students’ inclination to engage in gambling and in risk gambling. In more general terms, the study provides evidence that schools’ values and norms as reflected by the teachers’ ratings of their school’s ethos have the potential to counteract unwanted behaviours among the students.

School Ethos and Recurring Sickness Absence: A Multilevel Study of Ninth-Grade Students in Stockholm

School absence has been identified as a severe problem in Sweden, both at the individual level and for society as a whole. Despite the multitude and complexity of reasons behind school absence, health-related problems are likely to be one important determinant. This indicates that knowledge about factors that may contribute to preventing health-related absence among students is relevant. The aim was to investigate whether a higher level of teacher-reported school ethos was associated with less recurring sickness absence among students. Data from four cross-sectional surveys performed in 2014 and 2016 were combined. The Stockholm School Survey was carried out among 9482 ninth-grade students (ages 15-16 years) in 150 school units, and the Stockholm Teacher Survey was performed among 2090 teachers in the same units. School ethos was operationalised by an index of 12 teacher-reported items that was aggregated to the school-level. Recurring student sickness absence was captured by self-reports and defined as absence on >10 occasions during the current school year. Two-level logistic regressions were performed. The results show that about 9.5% of the students reported recurring sickness absence. Students attending schools with higher levels of teacher-rated school ethos were less likely to reporting recurring sickness absence than those attending schools with lower levels of ethos, even when adjusting for potential confounders (OR 0.79, 95% CI 0.65-0.97). In conclusion, recurring sickness absence was less common among students attending schools with higher levels of teacher-rated ethos. The findings suggest that schools may contribute to promoting student health.

Parent-youth conflict as a predictor of depression in adulthood: a 15-year follow-up of a community-based cohort

Experiencing conflictual relations with one's parents while growing up has been linked to onset, recurrence, and worse treatment outcome of adolescent depression. While this suggests that significant problems in the parent-youth relationship make depressive disorders more relentless, it is not clear whether this effect lasts into adulthood. Our aim was to examine if major and minor conflict with parents while growing up predicts depression in adulthood in youth with and without a history of depression. We utilized data from the Uppsala Longitudinal Adolescent Depression Study. This community-based cohort was assessed with structured diagnostic interviews both at age 16-17 and at follow-up 15 years later. The analyses included 382 individuals (227 with a history of child or adolescent depression; 155 peers without such a history). Binary logistic regression was used, adjusting for sex, disruptive behavior disorders, and additional family-related adversities. Among individuals with adolescent depression, major conflict with parents was strongly associated with adult depression (adjusted OR 2.28, 95% CI 1.07-4.87). While major conflict with parents was rare among non-depressed controls, a non-significant association of similar magnitude was still observed. Minor conflict, on the other hand, was not significantly associated with adult depression. Overall, conflict with parents did not predict adult anxiety disorders, substance use, suicidal behavior, somatoform disorders, or psychotic disorders. In conclusion, major parent-youth conflict during upbringing seems to be linked with an increased risk of depression in adulthood. These findings underscore the need to consider contextual/familial factors in the prevention and clinical management of early-life depression.

School effectiveness and students' future orientation: A multilevel analysis of upper secondary schools in Stockholm, Sweden

INTRODUCTION

Future orientation (FO) refers to individuals' beliefs and feelings about their future. Earlier research has primarily investigated correlates of FO at the individual and family level, but it seems likely that FO is also shaped by other central agents or institutions, such as the school. Earlier studies have found positive associations between "school effectiveness" and student performance, and negative associations in relation to e.g., bullying, delinquency, and health risk behaviors. The current study investigated three teacher-reported features of school effectiveness - school leadership, teacher cooperation and consensus, and school ethos - and their links with student-reported FO.

METHODS

Survey data were collected in 2016 among 5131 students (aged 17-18 years) and 1061 teachers in 46 upper secondary schools in Stockholm, Sweden, and merged with school-level register data. Two-level binary logistic regression analyses were performed.

RESULTS

The analyses showed that higher teacher ratings of school leadership and school ethos were associated with a greater likelihood of reporting an optimistic FO among students. Teacher cooperation and consensus was however not associated with students' FO.

CONCLUSION

The findings indicate that the school environment contributes to shaping students' beliefs about their future. Thus, enhancing features of school effectiveness may be a way of promoting a positive development and brighter objective future prospects for the young, via pathways such as good student-teacher relations and academic motivation and achievement.

National data study showed that adolescents living in poorer households and with one parent were more likely to be bullied

Aim

The aim of this study was to assess whether sociodemographic household characteristics were associated with which Swedish adolescents were more likely to be bullied.

Methods

The data were derived from the Swedish Living Conditions Survey and its child supplements from the survey years 2008–2011. The analyses included information on 3951 adolescents aged 10–18 years. Exposure to bullying was reported by adolescents, and information on sociodemographic household characteristics was reported by parents and obtained from official registers. Binary logistic regression was used to analyse the data.

Results

Adolescents were more likely to be bullied if they lived in households with no cash margin, defined as the ability to pay an unexpected bill of 8000 Swedish Kronor or about 800 Euros, and if they lived with just one custodial parent. In the unadjusted analyses, elevated risks were identified if adolescents lived in working class households and had unemployed and foreign‐born parents. However, these associations were at least partly accounted for by other sociodemographic household characteristics, in particular the lack of a cash margin.

Conclusion

This study showed that Swedish adolescents living in households with more limited financial resources had an increased risk of being bullied, supporting results from previous international research.

Parental separation in childhood as a risk factor for depression in adulthood: a community-based study of adolescents screened for depression and followed up after 15 years

BACKGROUND

Earlier research has investigated the association between parental separation and long-term health outcomes among offspring, but few studies have assessed the potentially moderating role of mental health status in adolescence. The aim of this study was to analyze whether parental separation in childhood predicts depression in adulthood and whether the pattern differs between individuals with and without earlier depression.

METHODS

A community-based sample of individuals with adolescent depression in 1991-93 and matched non-depressed peers were followed up using a structured diagnostic interview after 15 years. The participation rate was 65% (depressed n = 227; non-depressed controls n = 155). Information on parental separation and conditions in childhood and adolescence was collected at baseline. The outcome was depression between the ages 19-31 years; information on depression was collected at the follow-up diagnostic interview. The statistical method used was binary logistic regression.

RESULTS

Our analyses showed that depressed adolescents with separated parents had an excess risk of recurrence of depression in adulthood, compared with depressed adolescents with non-separated parents. In addition, among adolescents with depression, parental separation was associated with an increased risk of a switch to bipolar disorder in adulthood. Among the matched non-depressed peers, no associations between parental separation and adult depression or bipolar disorder were found.

CONCLUSIONS

Parental separation may have long-lasting health consequences for vulnerable individuals who suffer from mental illness already in adolescence.

The Living Conditions of Children with Shared Residence - the Swedish Example

Among children with separated parents, shared residence - i.e., joint physical custody where the child is sharing his or her time equally between two custodial parents' homes - is increasing in many Western countries and is particularly common in Sweden. The overall level of living among children in Sweden is high; however, the potential structural differences between children in various post-separation family arrangements have not been sufficiently studied. Potential risks for children with shared residence relate to the daily hassles and stress when having two homes. This study aims at investigating the living conditions of children with shared residence compared with children living with two custodial parents in the same household and those living with one custodial parent, respectively. Swedish national survey data collected from children aged 10-18 years (n ≈ 5000) and their parents were used. The outcomes were grouped into: Economic and material conditions, Social relations with parents and peers, Health and health behaviors, Working conditions and safety in school and in the neighborhood, and Culture and leisure time activities. Results from a series of linear probability models showed that most outcomes were similar for children with shared residence and those living with two custodial parents in the same household, while several outcomes were worse for children living with one parent. However, few differences due to living arrangements were found regarding school conditions. This study highlights the inequalities in the living conditions of Swedish children, with those living with one parent having fewer resources compared with other children.

Effort-reward imbalance in the school setting: associations with somatic pain and self-rated health

AIMS

According to the workplace theory of effort-reward imbalance (ERI), individuals who perceive a lack of reciprocity between their effort spent at work and the rewards received in turn are at an increased risk of stress-related ill-health. It is also assumed that being overcommitted to work is linked to an increased risk of stress-related ill-health. This study applies the effort-reward imbalance model to the school setting. It aims to analyse the associations that effort-reward imbalance and overcommitment share with somatic pain and self-rated health among adolescents.

METHODS

Data are from the School Stress and Support Study (TriSSS), involving students in grades 8 and 9 (ages 14-16 years) in two schools in Stockholm, Sweden, during 2010 (n=403). Information on effort-reward imbalance and health outcomes was gathered from self-report questionnaires. An adjusted short version of ERI was used. Factor analysis showed that extrinsic effort, reward and overcommitment constitute three distinct dimensions. The designed measures demonstrated sound psychometric properties both for the full sample and for subgroups. Ordered logistic regressions were conducted.

RESULTS

The analyses showed that low reward and higher overcommitment were associated with greater somatic pain and poorer self-rated health. Furthermore, effort-reward imbalance was linked with an elevated risk of somatic pain and poorer self-rated health.

CONCLUSIONS

Students are more likely to experience stress-related ill-health when they perceive an imbalance between their effort and rewards. In addition, high overcommitment is associated with an increased risk of ill-health among students.

Joint physical custody, turning to parents for emotional support, and subjective health: A study of adolescents in Stockholm, Sweden

AIMS

Among children with separated parents, the arrangement of joint physical custody, i.e. children living equally much in both parents' homes, has increased substantially during the last decades in Sweden. To date, empirical research on the living conditions of this group is limited. This study analyses family type differences in turning to parents for emotional support and in subjective health among adolescents. The focus of the study is adolescents in joint physical custody, who are compared with those living with two original parents in the same household; those living (only) in a single-parent household; and those living (only) in a reconstituted family.

METHODS

The data come from the Stockholm School Survey of 2004, a total population survey of students in grade 9 (15-16 years) in Stockholm (n=8,840). Ordinary least squares (OLS) regressions were conducted.

RESULTS

Turning to both parents about problems is most commonly reported by adolescents in intact families, followed by those in joint physical custody. Adolescents in non-traditional family types report worse subjective health than adolescents in intact families, but the difference is smaller for those in joint physical custody than for those living with a single parent. The slightly poorer health of adolescents in joint physical custody than those in intact families is not explained by their lower use of parents as a source of emotional support.

CONCLUSIONS

The study suggests that joint physical custody is associated with a higher inclination to use parents as a source of emotional support and better subjective health than other post-divorce family types.

School-performance indicators and subjective health complaints: are there gender differences?

Although boys and girls are generally located in the same physical school environment, it may be experienced differently by, and have varying implications for, boys and girls. Girls like school more and achieve higher school marks, but they also perceive more school-related pressure. Based on a total sample of 8456 ninth grade pupils in Stockholm in 2004, this study uses multilevel linear regression to analyse differences between boys and girls with regard to a number of school-performance indicators (demands, motivation, teacher support and school marks) and their association with subjective health complaints. Results showed that girls perceive more demands, show greater academic motivation, perform better in school and report more emotional support from teachers than boys. In contrast, instrumental and appraisal support from teachers are more commonly reported by boys. Associations between school-performance indicators and subjective health complaints were slightly stronger for girls than for boys. Contextual variation in health complaints, especially between classes, was found only for girls. High achievement motivation and emotional teacher support in the school class was associated with better pupil health, suggesting that a positive climate in terms of motivation and support favours class health as a whole.

Parent presence and gender-typicalness of educational choice

Given parental influence on children's educational choices, new family constellations may impact on sex segregation in school and thus in the labour market. This paper addresses the question of what consequence father absence and stepfather presence may have for choice of the male-dominated natural science/technology (NT) programme in Swedish upper secondary school. The data include register information on all pupils who attended the ninth grade of the Swedish compulsory school in 1998 and 1999 and their parents (n = 73,824). While children in mother-only households are less likely to choose the NT programme compared with children residing with two original parents, this is accounted for by differences in socioeconomic conditions and in grade sum. Fathers, like mothers, also have a more direct influence on children's educational choices of field of study via their own education and occupation. However, what has not been noted in previous research is that this also applies to 'absent' fathers and, for boys, to stepfathers as well.

The pros and cons of social relations: an analysis of adolescents' health complaints

This paper examines the association between social relations and psychological and psychosomatic health complaints, among adolescents in Sweden. We focused on relationships with parents, as well as relationships with peers in school and in leisure time. Both the structure and the content of relations were analysed. For the latter, we looked at supportive as well as strained relations. The data was the pooled child supplements of the Swedish welfare surveys conducted in 2000-2003. This constitutes a nationally representative, cross-sectional sample of 10-18-year-olds (n = 5137), where information was collected from both adolescents and their parents. Results showed that young people's social relations with parents and peers clearly covaried with their health complaints. With regard to family relations and psychological complaints, the association was more pronounced for relational content than for relational structure. For instance, whether relations with parents were strained or not seemed more relevant than family structure and parental working hours. Moreover, strained relations were more strongly associated with health complaints, especially psychosomatic complaints, than were supportive relations. This applied to relationships with parents as well as with peers in school.