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Mental health problems among adolescents in Sweden: Analysis of trends, developmental trajectories, and associated factors
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.ORCID iD: 0000-0003-1315-9603
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 [en]
Adolescent, mental health problems, trends, trajectories, Social Determinants of Health
National Category
Medical and Health Sciences
Research subject
Public Health Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-66623ISBN: 978-91-7485-652-1 (print)OAI: oai:DiVA.org:mdh-66623DiVA, id: diva2:1858327
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, 2019-00492Available from: 2024-05-20 Created: 2024-05-16 Last updated: 2024-06-10Bibliographically approved
List of papers
1. Trends in adolescent mental health problems 2004–2020: do sex and socioeconomic status play any role?
Open this publication in new window or tab >>Trends in adolescent mental health problems 2004–2020: do sex and socioeconomic status play any role?
2023 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims:This study aims to investigate trends in four types of adolescent mental health problems; that is, psychosomatic symptoms, depressive symptoms, suicidal ideations, and suicide attempts 2004–2020. A second aim is to investigate the moderating roles of socioeconomic status and sex in these trends.

Methods:The analysis is based on repeated cross-sectional data 2004–2020 among grade 9 students in secondary schools in a Swedish county. In total, data from 19,873 students were included in the analysis. We fitted linear and logistic regression equations and used survey-years’ coefficients to estimate the trends. We also estimated the moderating effects of socioeconomic status and sex using interactions between survey year and socioeconomic status and sex, respectively.

Results:The trends in all mental health problems declined over time. Through its interaction with survey year, socioeconomic status moderated the trends; psychosomatic symptoms (B = −0.115, P<0.001), depressive symptoms (B = −0.084, P<0.001) and suicidal ideations (odds ratio 0.953, confidence interval 0.924–0.983) significantly declined over time among those with high socioeconomic status. However, socioeconomic status did not have an association with the trend in suicide attempts. Interaction between sex and year of survey was associated with significant decreasing trends in depressive symptoms and suicidal ideations only among girls.

Conclusions:Adolescent mental health problems have decreased over time, but only for adolescents with high socioeconomic status, or only in depressive symptoms and suicidal ideations for girls. The results shed light on the growing inequalities in health outcomes across levels of socioeconomic status.

National Category
Medical and Health Sciences Health Sciences
Identifiers
urn:nbn:se:mdh:diva-62384 (URN)10.1177/14034948231165552 (DOI)000980095200001 ()2-s2.0-85158889938 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 00492
Available from: 2023-05-04 Created: 2023-05-04 Last updated: 2024-05-16Bibliographically approved
2. Trends in mental health problems among Swedish adolescents: Do school-related factors play a role?
Open this publication in new window or tab >>Trends in mental health problems among Swedish adolescents: Do school-related factors play a role?
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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.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-66219 (URN)10.1371/journal.pone.0300294 (DOI)001181701200063 ()38457463 (PubMedID)2-s2.0-85187514377 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-00492
Available from: 2024-03-11 Created: 2024-03-11 Last updated: 2024-05-16Bibliographically approved
3. Trends in psychosomatic symptoms among adolescents and the role of lifestyle factors
Open this publication in new window or tab >>Trends in psychosomatic symptoms among adolescents and the role of lifestyle factors
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2024 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, no 1, article id 878Article in journal (Refereed) Published
Abstract [en]

AbstractBackground Adolescent mental health problems are on the rise globally, including in Sweden. One indicator of this trend is increased psychosomatic symptoms (PSS) over time. Lifestyle factors such as physical activity (PA), diet, smoking, and alcohol consumption may influence the time trends in PSS; however, the evidence base is scarce. The aim of this study was to investigate associations between time trends in PSS and lifestyle factors. Methods The study was based on data collected from a nationally representative sample of 9,196 fifteen-year-old boys and girls in Sweden using the Health Behavior in School-aged Children (HBSC) symptom checklist. The sample comprised nearly equal proportions of girls (50.5%) and boys. The lifestyle factors examined in this study included PA, regular breakfast intake, consumption of fruits, vegetables, sweets, or soft drinks, smoking, and alcohol drunkenness. We used data from 2002 to 2018 and stratified by family affluence scale (FAS) to demonstrate how the associations varied among the FAS groups. We fitted separate regression models for the high- and low-FAS groups, where interaction terms between the year of the survey and each lifestyle factor were used to estimate the level and direction of associations between the factors and trends in PSS. Results There was a generally increasing trend in PSS mean scores from 2.26 in 2002 to 2.49 in 2018 (p<.001). The changes in each survey year compared to the average mean scores during the preceding years were significant in all years except 2010. Regular breakfast intake, daily fruit and vegetable consumption, and higher PA were associated with lower PSS mean scores, while smoking and drunkenness had opposite associations with PSS. The only significant interaction between the survey year and the lifestyle factors was observed regarding drunkenness in the high FAS group, suggesting that the association between trends in PSS and the experience of getting drunk at least twice got stronger over time (B=0.057; CI:0.016, 0.097; p<.01).Conclusions The results indicate increasing trends in PSS among young people in Sweden from 2002 to 2018, with a significant increase observed among adolescents in the high FAS group who reported getting drunk on at least two occasions. 

Keywords
Adolescent, mental health, psychosomatic symptoms, lifestyle factors, trends
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-66309 (URN)10.1186/s12889-024-18327-x (DOI)38515098 (PubMedID)2-s2.0-85188601608 (Scopus ID)
Funder
Mälardalen University, 2019−00492
Available from: 2024-03-26 Created: 2024-03-26 Last updated: 2024-05-16Bibliographically approved
4. The impact of family and peer relationships on developmental trajectories of depressive and anxiety symptoms among young people
Open this publication in new window or tab >>The impact of family and peer relationships on developmental trajectories of depressive and anxiety symptoms among young people
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Adolescent mental health is a growing global concern, with depressive and anxiety symptoms on the rise over recent decades. The significance of supportive social relationships, particularly within family and peer groups, is well-established in research. However, limited evidence exists on the impact of social relationships in predicting the developmental trajectories of mental health problems over time.

Methods: This study aims to fill this gap by identifying distinct trajectories of depressive and anxiety symptoms among adolescents and exploring the impact of various factors, including family relationships, peer relationships, sex, and country of origin, on predicting individuals' likelihood of belonging to specific trajectories. Based on data collected from adolescents in Sweden born in 1997 and 1999, the study utilized Group-Based Trajectory Modeling (GBTM) to analyze longitudinal data. Statistical analyses, including multinomial logistic regression, were conducted to examine the predictive effects of social relationships on depressive and anxiety symptom trajectories.

Results: Positive social relationships with family and peers emerged as robust predictors across depressive and anxiety symptom trajectories. Female participants consistently exhibited higher mean scores of depressive and anxiety symptoms than males, while participants originating from countries outside the Nordic region were at higher risk of belonging to depressive symptom trajectory groups with higher mean scores. Despite limitations such as high attrition rates, the study's methodological rigor offers valuable insights into the predictive effects of social relationships on mental health trajectories.

Conclusions: The study underscores the importance of addressing social factors in adolescent mental health prevention strategies. Despite facing limitations such as high attrition rates, the study's strengths lie in its methodological rigor, providing valuable insights into the predictive effects of social relationships on mental health trajectories and addressing crucial gaps in the literature. This pioneering approach offers implications for future intervention and prevention strategies, emphasizing the importance of social factors in understanding and addressing adolescent mental health.

Keywords
depressive symptoms, anxiety, trajectory, social relationships, adolescents
National Category
Medical and Health Sciences
Research subject
Public Health Sciences
Identifiers
urn:nbn:se:mdh:diva-66619 (URN)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-00492
Available from: 2024-05-16 Created: 2024-05-16 Last updated: 2024-05-20Bibliographically approved

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The full text will be freely available from 2024-08-16 08:00
Available from 2024-08-16 08:00

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