Do changes in the psychosocial school environment influence pupils' health development? Results from a three-year follow-up study

Caring Climate and Support, Mental Health, and Academic Adjustment: Effects from a Cluster Randomized Controlled Trial in Upper Secondary Schools in Norway

This cluster randomized controlled trial (RCT) examined the effect of a three year follow up of a multi-tier intervention aiming at improving the psychosocial environment in upper secondary schools in Norway. Two intervention conditions were tested: a universal single-tier intervention focused on improving the psychosocial school climate, the dream school program (DSP), and a multi-tier intervention combining the DSP with a targeted measure, the mental health support team (MHST). A total of 2203 students responded to the baseline survey. Of the 2203 pupils, 1884 responded to the first follow-up survey (year 1), 1287 pupils to the second (year 2), and 756 pupils to the third (year 3). The direct and indirect effects on school completion were analyzed using a multi-level linear mixed model. The results showed no significant effects of either the DSP or the DSP and MHST in combination on support, the school climate, mental health, or academic adjustment. We found no significant effect of the interventions on the proportion who had completed school or were in training (the three groups varied between 76.6% and 77.8%). Future similar studies should be attentive to the potential challenges of implementing RCTs in the school setting. Furthermore, the long-term effects of school interventions on the constructs included in this study could be difficult to capture due to the complexity of the phenomena. The implications of these findings are discussed.

Preventing Loneliness and Reducing Dropout: Results from the COMPLETE Intervention Study in Upper Secondary Schools in Norway

This study examines the impact of interventions aimed at improving psychosocial health on students' perception of a caring school climate, their feelings of loneliness, and school completion in Norwegian upper secondary education. Two intervention conditions were tested: a universal single-tier intervention focused on improving the psychosocial school climate: the Dream School Program, and a multi-tier intervention combining the Dream School Program with a targeted measure, the Mental Health Support Team. The direct and indirect effects of these interventions on school completion were analyzed using structural equation models (SEM), with data from 1508 students (mean age at Time 1: 17.02 (SD = 0.92); 60.7% girls; 72.1% Norwegian-born). The results indicated that loneliness levels did not differ significantly between the intervention conditions. However, students in the multi-tier intervention group reported a significantly higher perception of a caring school climate compared to those in the single-tier intervention group. The multi-tier intervention group had a lower rate of school completion compared to the control group and the single-tier intervention group. The SEM analysis revealed that the multi-tier intervention reduced loneliness in the second year of upper secondary school by promoting a caring school climate in the first school year. In contrast, the single-tier intervention was associated with increased loneliness due to a decrease in the perception of a caring school climate. The implications of these findings are discussed.

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.

Adolescent screen time: associations with school stress and school satisfaction across 38 countries

This study examined associations of watching television, electronic games, computer uses with school stress, and satisfaction among adolescents. Nationally representative data from 38 European and North American countries that participated in the 2014 Health Behaviour in School-aged Children (HBSC) survey were analysed. School stress and school satisfaction were each assessed using a 4-point self-reported item and then dichotomised. Participants reported discretional time spent on different screen-based activities. Of the 191,786 participants (age 13.6 [1.6] years; 51% girls), 35% reported high levels of school stress, while 30% reported high satisfaction with their school. Multilevel multivariable logistic regression modelling showed that adolescents reporting watching television > 4 h/day (≤ 1 h/day as reference) had 31% higher odds of school stress (OR 1.31; 95% CI: 1.27-1.35) and 36% less odds of school satisfaction (OR 0.64; 95% CI: 0.62-0.67). Prolonged electronic gaming (> 4 h/day) increased the odds of school stress by 26% (OR 1.26; 95% CI: 1.22-1.30) and decreased the odds of school satisfaction by 37% (OR 0.63; 95% CI: 0.61-0.65). Adolescents with prolonged computer use had 46% higher odds of school stress (OR 1.46; 95% CI: 1.42-1.50) and 39% lower odds of school satisfaction (OR 0.61; 95% CI: 0.59-0.63). Association estimates were more evident among younger adolescents than their older counterparts with no apparent gender differences.

CONCLUSION

Prolonged screen use, irrespective of type, was positively associated with school stress and inversely associated with school satisfaction with high computer use showing the highest adverse associations. Prospective research is needed to understand directionality and mechanisms of these relationships.

WHAT IS KNOWN

• Screen-based activities are adversely associated with various health and wellbeing indicators in adolescents.. • The relation between screen time and school-related outcomes is yet to understand fully.

WHAT IS NEW

• Prolonged screen time is associated with increased school stress and decreased school satisfaction in adolescents. • Computer use showed higher adverse associations than watching television or playing electronic games.

Prevalence and factors associated with depression among higher secondary school adolescents of Pokhara Metropolitan, Nepal: a cross-sectional study

OBJECTIVE

This study examined the prevalence and factors associated with depression among adolescents attending higher secondary schools in the Pokhara Metropolitan City of Nepal.

DESIGN

A cross-sectional study design was adopted.

SETTING

Four randomly selected higher secondary schools of Pokhara Metropolitan, Nepal.

PARTICIPANTS

312 randomly sampled higher secondary school students.

METHODS

The Center for Epidemiologic Studies Depression Scale was used to assess the level of depression among students. The data collected through a self-administered questionnaire were analysed using descriptive statistical methods such as frequency and percentage. χ² test and unadjusted OR (UOR) were calculated to assess the statistical relationship between depression and various variables at 95% CI, with level of significance at p<0.05.

RESULTS

The study found a high prevalence of depression among high school students, with more than two-fifths (44.2%) of students having depression. Furthermore, almost a quarter (25.3%) of the students were noted to have mild depression and 18.9% of the students expressed major depression. Students who had low perceived social support (UOR: 3.604; 95% CI 2.088 to 6.220), did not share their problems with anyone (UOR: 1.931; 95% CI 1.228 to 3.038) and had low self-esteem (UOR: 5.282; 95% CI 2.994 to 9.319) were at higher odds of being depressed.

CONCLUSION

A high prevalence of depression was observed among high school students. It was also observed that students' level of perceived social support, self-esteem and help-seeking behaviour are somehow related to their mental well-being. Hence, improving social support and self-esteem may alleviate depression and mental distress among these adolescents.

Classroom Disorder and Internalizing Problems Among Swedish Adolescents: Changes Between 1988 and 2011

BACKGROUND

Internalizing problems have increased among Swedish adolescents. We examined whether classroom disorder was associated with internalizing problems and whether it explained the trends in internalizing problems. Furthermore, we examined whether school contextual factors were associated with internalizing problems and whether they moderated the association between classroom disorder and internalizing problems.

METHODS

We used repeated cross-sectional survey data (1988-2011) among all 15- to 16-year-old students in Värmland, Sweden (N = 9491 boys, N = 9313 girls). School-level factors were the proportions of students with a low/average socioeconomic or an immigration background.

RESULTS

Results from mixed effects models showed that classroom disorder was associated with internalizing problems across the years of investigation but did not explain the trends in internalizing problems. This association was moderated by the school-level proportion of students with a low/average socioeconomic background but not the school-level proportion of students with an immigration background.

CONCLUSIONS

Students who perceived their classroom to be disorderly more often also reported more internalizing problems. Future studies are necessary to investigate other potential school factors that may explain the trends in internalizing problems.

School Satisfaction and School Pressure in the WHO European Region and North America: An Analysis of Time Trends (2002-2018) and Patterns of Co-occurrence in 32 Countries

PURPOSE

The purpose of the study was to examine the trends between 2002 and 2018 in school pressure and school satisfaction among 15-year-old students, across countries and by gender, in the WHO European region and North America, and explore whether there are variations between countries and by gender in the co-occurrence of school pressure and school satisfaction.

METHODS

Data from the 32 countries that participated in the Health Behaviour in School-aged Children study (HBSC) study between 2002 and 2018 were used. Statistical analyses included t-tests, binary logistic regression analyses, and chi-square tests, as required by each of the study aims.

RESULTS

School satisfaction tended to increase over the period 2002-2018 among boys, whereas school pressure increased among girls. Also, gender differences tended to dissipate in school satisfaction and generally increase in school pressure. The co-occurrence of school satisfaction and school pressure in 2017/2018 shows that the majority of students are found in the "not pressured-not highly satisfied" and "pressured-not highly satisfied" groups. There were more boys in the former group and more girls in the latter group.

CONCLUSION

Few students in the 32 countries belonged to the "not pressured-highly satisfied" group, which from a public health perspective may be seen as the most desirable group. The increases in school pressure in girls from 2002 to 2018 and their overrepresentation in the pressured groups require further attention.

The Role of Academic Achievement in the Relationship between School Ethos and Adolescent Distress and Aggression: A Study of Ninth Grade Students in the Segregated School Landscape of Stockholm

Equitable access to high-quality schools is important for student achievement. However, the increasing attention placed on adolescent mental health promotion suggests that school contextual factors and school achievement may also play an important role for students’ psychological well-being. This study examined the relationships between school ethos, academic achievement, psychological distress and aggressive behaviour among Swedish students, further considering the role of school sociodemographic composition. Analyses were based on two separate data collections in Stockholm, one among teachers (n = 2089) and the other among students aged 15–16 (n = 9776; 49.7% girls). Using multilevel structural equation modelling, the relations between teachers’ reports of school ethos and students’ reports of achievement, psychological distress and aggressive behaviour were tested. Analyses showed a positive relationship between a school’s ethos and average academic achievement. At the school level, higher academic achievement was in turn associated with less psychological distress among students, providing an indirect pathway between school ethos and psychological distress. At the individual level, students with higher academic achievement reported less psychological distress and aggressive behaviour. These findings indicate that schools’ value-based policies and practices can play a role for students’ academic performance, and through this, for their psychological well-being.

Is being a "small fish in a big pond" bad for students´ psychosomatic health? A multilevel study on the role of class-level school performance

Background

Features of schools and classes are closely related to students´ health and wellbeing. However, class composition (e.g. in terms of school performance) has rarely been examined in relation to students´ health and wellbeing. This study focuses on the so called Big-Fish-Little-Pond-Effect (BFLPE), by investigating whether the level of high-performing students in classroom is negatively associated with psychosomatic complaints of students who perceive themselves as poor performers.

Methods

Data were derived from the German sample of the WHO-Collaborative “Health Behaviour in School-aged Children (HBSC)” study 2013/2014. The sample included 5226 11-, 13- and 15-year-old students. Individual perceived school performance (PSP) was included (very good/good vs. average/below average PSP) at the individual student-level. At the class-level, school performance in class was generated by aggregating the share (in percentage) of students who report a very good/good PSP to the class-level, indicating the percentage of students with good/very good PSP in classroom. Using multilevel regression models, the association between class-level school performance (in percentage of students with very good/good PSP) and individual psychosomatic complaints were analyzed, stratified by students´ individual PSP.

Results

Students who report average/below average PSP showed higher likelihoods of psychosomatic complaints (Odds Ratio: 1.75; 95% Confidence Interval: 1.52–2.03) compared to counterparts with very good/good PSP. The aggregated class-level PSP was not significantly associated with psychosomatic complaints. However, in line with the BFLPE, results further revealed that students with average/below average PSP, who attend classes with a higher percentage of students who report very good/good PSP, had higher likelihoods of psychosomatic complaints (Odds Ratio: 1.91; 95% Confidence Interval: 1.01–4.01) compared to classmates with very good/good PSP.

Conclusions

This study revealed that class composition in terms of PSP was differentially associated with students´ psychosomatic complaints, depending on their individual PSP. Findings highlight the vulnerability of students with poor PSP placed in classes with a higher percentage of students with good PSP. Results of this study therefore indicate a need for initiatives for low performing students from teachers and school staff in class.

Self-reported school demands and psychosomatic problems among adolescents - changes in the association between 1988 and 2011?

AIMS

The aim of the present study was to examine changes over time in the relationship between self-reported school demands and psychosomatic problems, also considering the impact of student influence and teacher support.

METHODS

Data from a cross-sectional study (Young in Värmland) including eight data collections (1988-2011) among Swedish students aged 15-16 were used ( n = 20,115). Analyses with multinomial logistic regression and descriptive statistics were applied.

RESULTS

Between 1988 and 2011, the proportions of students with a higher degree of psychosomatic problems increased, as did the proportion of students experiencing school demands that were too high. Finer-level analyses based on stratification of student groups did not show any associations at the aggregated level between increases of school demands and psychosomatic problems. Similarly, individual level analyses showed that the strength of the association between school demands and psychosomatic problems was not affected by year of investigation.

CONCLUSIONS

Changes in school demands over time could not explain the increasing trend in psychosomatic problems among adolescents. Since the relationship between school demands and psychosomatic problems is strong across time, there is, however, a continued need for school-based interventions. More studies are required to gain further understanding of adolescent mental health from a trend perspective.

School experiences may be important determinants of mental health problems in middle childhood - a Swedish longitudinal population-based study

AIM

Little is known about the association between school experiences and mental health in young schoolchildren. This study explored the cross-sectional and prospective associations between children's school experiences and mental health in middle childhood.

METHODS

We gathered comprehensive population-based data on the school experiences and mental health of 592 schoolchildren attending grades three and six in Sweden (ages approximately nine and 12 years). The KIDSCREEN questionnaire was used to measure school experiences in both age groups while the Child Behavior Checklist and the Strengths and Difficulties Questionnaire measured mental health in grades three and six, respectively.

RESULTS

Children with problematic school experiences in grade three had an approximately two times higher odds for concurrent total, internalised, externalised, attention-hyperactivity and social problems. They also had a 1.5-2.5 higher odds for these mental health problems three years later. Likewise, there was an association between problematic school experiences in grade three and lower levels of prosocial behaviour three years later. These associations were shown in both boys and girls, but were particularly pronounced in girls.

CONCLUSION

This study indicated that school experiences in young schoolchildren may be important determinants of concurrent and later mental health problems.

Awareness of demands and unfairness and the importance of connectedness and security: Teenage girls' lived experiences of their everyday lives

In recent years, a number of studies have demonstrated that stress and mental health problems have increased among adolescents and especially among girls, although little is still known concerning what girls experience in their everyday lives. The aim of this study was to describe the phenomenon of teenage girls’ everyday lives, as experienced by the girls themselves. A phenomenological approach of reflective lifeworld research was used, and the findings are based on eight qualitative interviews with girls aged 13–16 years. The essence of teenage girls’ everyday lives as experienced by the girls themselves can be described as consciousness regarding demands and unfairness and regarding the importance of connectedness and security. The girls are aware of the demands of appearance and success, and they are conscious of the gender differences in school and in the media that affect them. The girls are also conscious about the meaning of connectedness with friends and family, as well as the importance of the security of their confidence in friends and feeling safe where they stay. If teenage girls feel connected and secure, protective factors in the form of manageability and meaningfulness can act as a counterweight to the demands and unfairness of everyday life. For professionals who work with teenage girls, the results from this study can be important in their work to support these girls.

Emotional symptoms among adolescents: epidemiological analysis of individual-, classroom- and school-level factors

BACKGROUND

Large proportions of schoolchildren suffer from emotional symptoms and there are large variations across schools. It is unknown to what degree this variation is due to composition of schoolchildren in each school or to contextual factors. Objectives are to identify factors at individual, classroom and school levels associated with emotional symptoms.

METHOD

Data stem from the Danish contribution to the international Health Behaviour in School-aged Children study 2010 including 4922 schoolchildren aged 11-15-years from a random sample of schools and including data from school leaders. Emotional symptoms are defined as daily presence of at least one of four symptoms: feeling low, irritable or bad tempered, nervous and having difficulties falling asleep. Multilevel multivariable logistic regression analyses are applied to identify and quantify factors at individual, classroom and school level.

RESULTS

Schoolchildren from low (odds ratio (OR) 1.70, 95% CI: 1.33-2.17) and medium (OR 1.50, 95% CI: 1.22-1.85) occupational social class (OSC), girls (OR 1.32, 95% CI: 1.13-1.56) and schoolchildren exposed to bullying (OR 3.82, 95% CI: 2.71-5.40), had increased odds for emotional symptoms. A negative classroom climate was associated with emotional symptoms (OR 1.29, 95% CI: 0.99-1.69) and so was being part of classrooms with a high prevalence of bullying (OR 1.28, 95% CI: 1.0-1.60).

CONCLUSION

Female sex, low OSC, single parent family, exposure to bullying and a high prevalence of bullying within a class are all associated with emotional symptoms. Most variation across schools is explained by individual-level factors but psychosocial aspects of the classroom environment also play a role.

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.

Effort-reward imbalance at school and depressive symptoms in Chinese adolescents: the role of family socioeconomic status

Depression is a major mental health problem during adolescence. This study, using a sample of Chinese adolescents, examined the separate and combined effects of perceived school-related stress and of family socioeconomic status (SES) on the prevalence of depressive symptoms. A total of 1774 Chinese students from Grades 7–12 were recruited into our questionnaire survey. School-related stress was measured by the Effort-Reward Imbalance Questionnaire-School Version, family SES was assessed by a standardized question, and depressive symptoms were evaluated by the Center for Epidemiological Studies Depression Scale for Children. Multivariate logistic regression was applied, adjusting for age, gender, grade, smoking, alcohol drinking and physical activity. It was found that high school-related stress and low family SES were associated with elevated odds of depressive symptoms, respectively. The effect of school-related stress was particularly strong in low SES group. In adolescents with both high stress at school and low SES, the odds ratio was 9.18 (95% confidence interval = 6.53–12.89) compared to the reference group (low stress at school and high SES). A significant synergistic interaction effect was observed (synergy index = 2.28, 95% confidence interval = 1.56–3.32). The findings indicated that perceived school-related stress, in terms of effort-reward imbalance, was related to depressive symptoms in this sample of Chinese adolescents. The strong interaction with family SES suggests that health promoting efforts in school settings should be targeted specifically at these socially deprived groups.

Psychosocial working conditions: an analysis of emotional symptoms and conduct problems amongst adolescent students

This study explored how psychosocial features of the schoolwork environment are associated with students' mental health. Data was drawn from 3699 ninth grade (15 year-old) Swedish students participating in the Health Behaviour in School-Aged Children survey. Using Structural Equation Modelling, perceived school demands, decision control and social support from teachers, classmates and parents were examined in relation to students' emotional and conduct problems. Higher demands were associated with greater emotional symptoms and conduct problems. Although weaker social support predicted emotional symptoms and conduct problems, the relative influence of teachers, classmates and parents differed. Teacher support was more closely associated with conduct problems, particularly for girls, while classmate support was more strongly related to emotional symptoms. The findings indicate that while excessive school pressure is associated with poorer mental health, social support can assist in optimising adolescents' emotional health and adaptive behaviour, as well as shaping perceptions of demands.

Self-perceived psychosomatic health in Swedish children, adolescents and young adults: an internet-based survey over time

OBJECTIVES

The authors investigated self-perceived psychosomatic health in young people (10-24 years of age) in Sweden and analysed different samples during the years 2005 and 2007-2010 via a community website.

DESIGN

Repeated cross-sectional surveys: (1) single question on a single day in 2005. (2) One specific question delivered on each of eight separate days in 2005. (3) The same eight questions delivered to smaller groups on the same day in 2007 and then again to randomly selected subjects in 2010.

SETTING

Validated questionnaires launched on the internet by a recognised Swedish community site. Study participants were invited to answer questions about their health with full anonymity as they logged into their personal area.

PARTICIPANTS

10-24-year-old children, adolescents and young adults.

PRIMARY AND SECONDARY OUTCOME MEASURES

Self-reported psychosomatic health in terms of sex and age over time.

RESULTS

A large number of responses were obtained (up to 140 000). The response rate for the single item on stress was 41%. A high percentage of young subjects responded that they felt stressed very often/often; the numbers were higher for women (47%) than for men (29%). Older teenaged women had more psychosomatic complaints than did men of similar ages; in contrast, among 10-12-year-old children, the percentage of psychosomatic complaints was similar for men and women. When comparing results obtained in 2010 with those obtained in 2007, young people of both sexes had a slightly better self-perceived health status in 2007.

CONCLUSIONS

During the period 2005-2010 a high percentage of young people, particularly females, 16-18 years of age, had psychosomatic complaints and considered themselves as being often or very often stressed. These complaints were more pronounced in the older age groups. When directing questions to a large community, internet-based surveys appear to be valuable tools.

Norm compliance and self-reported health among Swedish adolescents

AIMS

This study examines the relationship between norm compliance and self-reported health in adolescents, and how this differs between genders. Our specific aim was to investigate if extremely high norm compliance revealed any particular health patterns.

METHODS

This empirical study used a web-based survey from 2005, which was distributed to all students (n = 5,066) in years 7-9 of compulsory school within six municipalities in northern Sweden. The respondents answered questions about their general health as well as specific health problems such as headaches, stomach ache, sleeping difficulties and stress. Compliance was measured according to different norm-related behaviour, such as truancy, crime and use of tobacco, alcohol and narcotics.

RESULTS

The majority of respondents reported good health and norm-compliant behaviour. Girls reported more health problems than boys, a difference that increased with age. Those who were more norm compliant reported better health, fewer somatic complaints and less stress, which goes against our initial hypothesis that extremely high norm compliance and self-reported ill-health are related. There seemed to be a stronger relationship between self-reported health and norm compliance for girls than boys, in absolute terms.

CONCLUSIONS

The results clearly show a relationship between norm compliance and health, and suggest inequalities between genders.

Deliberate self-harm and associated factors in 17-year-old Swedish students

BACKGROUND

Deliberate self-harm (DSH) in young people is an important public health issue. To prevent DSH, more knowledge is needed about its prevalence and associated contextual factors in community samples of adolescents.

AIMS

To determine the prevalence of deliberate self-harm in 17-year-old Swedish students and to explore the association of demographic variables, psychological distress, experiences of violence, and school-related factors with DSH.

METHODS

Data were derived from a cross-sectional study in which 17-year-old students completed questionnaires during school hours (n = 1,663; 78.3%). The variables used in this analysis are as follows: deliberate self-harm, demographic variables, psychological distress, experiences of violence, and school-related factors. Data were analysed using chi-squared statistics and logistic regression.

RESULTS

The lifetime prevalence of DSH was 17%, and it was more common among girls (23.3%) than boys (10.5%). There were considerable socioeconomic differences in reports of DSH. Psychological distress was strongly associated with DSH in both boys and girls, as were experiences of bullying, sexual harassment, physical violence and sexual assault. Social support, safety and academic factors in school were related to reports of DSH in both girls and boys. There were some gender differences with respect to which factors were associated with DSH.

CONCLUSIONS

Deliberate self-harm is common and more frequently reported by girls than boys. Psychological distress, experiences of different types of violence, and school-related factors (academic, social and safety-related), should be considered risk factors for DSH in young people. Findings can be applied to health-promotion policy and interventions in various contexts, for example schools.

School demands and subjective health complaints among Swedish schoolchildren: a multilevel study

OBJECTIVES

As children spend a great deal of their time in school, the climate in the classroom can constitute a resource, but also a risk factor in the development of the pupils' health. The aim of the present study was to determine the extent to which demands in the classroom are associated with subjective health complaints in Swedish schoolchildren.

METHODS

Data from the 2001/2002 and 2005/2006 Swedish cross-national Health Behaviour in School-aged Children (HBSC) survey were analysed using a multilevel logistic regression technique.

RESULTS

The study demonstrated a substantial variation between school classes in pupils' subjective health complaints. In school classes with high demands, the odds of having subjective health complaints was about 50% higher than in school classes with low demands. Further, the results indicated that these effects were mediated by sex so as to girls being more affected by high levels of demands in the school class.

CONCLUSIONS

The findings are important since they point at the crucial role that teachers play in creating a favourable school climate. Therefore interventions aiming at supporting teachers to set realistic demands and expectations are one way to improve the school climate. Such interventions should also make clear the need to take into consideration the fact that the school class effect was mediated by sex, i.e. girls being more vulnerable to high level of school class demands.

Psychosocial working conditions, school sense of coherence and subjective health complaints. A multilevel analysis of ninth grade pupils in the Stockholm area

This study explores the psychosocial working conditions of 7930 Swedish 9th grade students, distributed over 475 classes and 130 schools, in relation to their subjective health using multilevel modeling. At the individual level, students with "strained" working conditions in school (i.e. those experiencing a high level of demands in combination with a low level of control) demonstrated significantly worse health compared to students in "low-strain" situations. "Strained" conditions in combination with a weak school-related sense of coherence were especially unfavourable for health. These findings remained significant when support from teachers, school marks, norm-breaking behaviours, family-relations and certain class- and school-contextual conditions were adjusted for. Thus, while demands are an essential part of school work, this study suggests that high levels of control and a strong school-related sense of coherence can protect against the more detrimental effects on health that high demands at school may cause.

Self-concept and mental health status of 'stay-at-home' children in rural China

AIM

To describe the self-concept and mental health status of 'stay-at-home' children and to explore the differences between stay-at-home children and non-stay-at-home children.

METHODS

A cross-sectional survey was conducted in Changfeng County to collect information on self-concept and mental health status. Children were classified as 'stay-at-home' or 'non-stay-at-home' for data analysis.

RESULTS

Stay-at-home children accounted for 55.1% of children. The two groups of children differed significantly on the total scores of self-concept (stay-at-home, 52.48 +/- 14.29; non-stay-at-home, 55.24 +/- 15.10). The mental health status of stay-at-home children was poor, with significant difference between them (stay-at-home, 41.17 +/- 12.25; non-stay-at-home, 40.14 +/- 13.11). Using multivariate linear regression analysis, we found that the total P-H score, gender, low family economic status, stay-at-home status and being cared for by an uncle/aunt or an older sibling were independent variables for mental health of the children.

CONCLUSION

This study suggests that stay-at-home children have a greater risk of mental health problems than their counterparts in rural Anhui province, China. In addition, this study provides useful baseline information on childhood mental health and has identified important risk factors that would be important in planning strategies for prevention of mental health problems for stay-at-home children.

Back-to-School Health Promotion

This review discusses school-based health promotion, including evidence-based perspectives on the school's feasibility as a venue for lifestyle risk reduction and disease prevention efforts. Future directions for inquiry and implications for empirically driven public policy initiatives are addressed.

My peers, my friend, and I: peer interactions and somatic complaints in boys and girls

In this article we present two studies about the relations between peer relationships and somatic complaints in children in Den Bosch, the Netherlands. In the first study (n=711), when the children were average 10 years old, we focused on social status as rated by classmates (popular, neglected, controversial, rejected, and average), self-reported social anxiety and somatic complaints. The second study (n=688) conducted 1.5 years later on the same sample, focused on possible positive influences of best friends on somatic complaints. We analyzed how reciprocity of the friendship, self-reported disclosure with the nominated best friend and self-reported emotion communication skill were related to children's somatic complaints. The results indicate an influence of peer interactions on somatic complaints. Social anxiety was associated with more somatic complaints, but peer status was unrelated to somatic complaints. Further, for girls with a reciprocated best friend, emotion communication skill was related to fewer somatic complaints. For boys emotion communication skill was negatively associated with somatic complaints when their friendship was unreciprocated, whereas disclosure with the nominated peer was related to the experience of more complaints in this case. The results indicate different associations of the sharing of emotions among boys and girls with regard to somatic complaints. It should be noted that self-reports on relationships and health may overlap more than classmates' reports of peer status because of shared method variance.

School stressors, psychological complaints and psychosomatic pain

BACKGROUND

The proportion of Scandinavian school children reporting psychosomatic pain and psychological complaints have increased in recent decades. In this study we investigated these symptoms in relation to potential stressors in the school environment.

METHODS

A cross-sectional study was conducted based on child interviews linked to nationally representative household surveys in Sweden during 2002-2003 covering a sample of 2588 children aged 10-18 years. The main outcome variable of psychosomatic pain signified suffering from headache as well as recurrent abdominal pain on a weekly basis.

RESULTS

School stressors, such as harassment by peers, schoolwork pressure and being treated poorly by teachers, were associated with psychosomatic pain as well as psychological complaints such as sadness, irritability, feeling unsafe and nervous. Harassment was identified as a particularly important determinant with adjusted odds ratios (ORs) ranging from 3.1 to 8.6 for psychosomatic pain. All psychological complaints were associated with psychosomatic pain with adjusted ORs ranging from 2.2 to 3.7, and mediated most of the association of harassment to psychosomatic pain.

CONCLUSIONS

School stressors are strongly associated with psychosomatic pain and psychological complaints in school children. Psychological complaints seem to function as mediators in the association of school stressors to psychosomatic pain symptoms to a great extent.

A new short self-rating questionnaire to assess stress in children

We constructed a test to assess stress in children and compared it with established measures of depression, anxiety, angel; disruptive behavior, and negative self-perception. A total of 181 children aged between 9 and 12 years were enrolled at various stages of the construction of a new short questionnaire; Stress in Children (SiC). Baseline data, completed questionnaires, salivary cortisol (SC)five times during (1 day), and 24-h urinary catecholamines were collected during an ordinary school week. The SiC was validated using the Beck Youth Inventories of Emotional andnt (BYI). Associations with self-reported psychosomatic symptoms for urinary catecholamines and cortisol concentrations were assessed. Cronbach's 6 used in this study for the entire SiC questionnaire is 0.86. Statistically significant associations were found between the SiC Global Mean Score (GMS) and all of the five BYI subscales. Spearman's rho coefficient for the association of SiC GMS with the first SC sample is 0.30 (p = 0.01). When stratified by sex, the magnitude of the association between SC and SiC was higher in girls, while there was no significant association among boys. No significant associations with catecholamine levels were observed for self-rating scores from the SiC or BYI. This study demonstrated that the SiC questionnaire has satisfactory reliability and its ratings are associated with those generated by the BYI. The SiC GMS was associated with higher morning saliva cortisol in girls. Our results demonstrate that it is possible to screen for stress in schoolchildren using an easily administered self-rating instrument.

Health behaviour and sense of coherence among pupils aged 14–15

AIM

The overall aim of the study was to investigate if there was a relationship between health behaviour and sense of coherence (SOC) in pupils aged 14-15. A specific aim was to investigate if socioeconomic areas and sex could be related to health behaviour and SOC of these pupils.

METHOD

A cross-sectional study was conducted in a sample of pupils in grade eight selected from primary schools in Stockholm city with regard to socioeconomic area. The final sample of the study was 383: 196 girls and 187 boys. Two questionnaires, the Health Profile Scale measuring health behaviour and the Sense of Coherence Scale were used to collect data.

RESULTS

Of the total group, girls had a significantly lower SOC mean score compared to boys. There were differences in health behaviour related to both SOC and sex. In comparison with boys, the girls showed a lower SOC in several health behaviours, e.g. breakfast, dinner, alcohol and bed-going habits. The pupils in the high socioeconomic area showed a low SOC score in several health behaviours.

CONCLUSION

The findings in this study were that girls aged 14-15 had a lower SOC mean score compared to boys. The girls showed a lower SOC score related to several health behaviours. There were no significant differences in the SOC mean scores between the two socioeconomic areas.

A possible contributor to the higher degree of girls reporting psychological symptoms compared with boys in grade nine?

BACKGROUND

It is a recurrent finding that adolescent girls report psychological symptoms in a higher degree compared with boys. The explanations for this difference vary, but the psychosocial school environment has never been a focus in these explanations. The aim of this study was to analyse whether psychosocial factors at school were associated with a high degree of psychological symptoms among boys and girls in grade nine, with a special focus on sexual harassment.

METHODS

The study was based on a cross-sectional study including 336 pupils (175 girls and 161 boys) in grade nine (about 15 years old), who answered an extensive questionnaire. The non-response rate was negligible (<1%). Logistic regression analysis was used to analyse whether school-related factors (teacher support, classmate support, sexual harassment), body image, and parental support were associated with a high degree of psychological symptoms.

RESULTS

Sexual harassment at school was associated with a high degree of psychological symptoms among girls.

CONCLUSIONS

Sexual harassment must be acknowledged as a negative psychosocial school environmental factor of importance for the high degree of psychological ill-health symptoms among girls compared with boys.