A national cohort study of parental socioeconomic status and non-fatal suicidal behaviour--the mediating role of school performance

Parental education level and adolescent depression: A multi-country meta-analysis

Adolescent depression, as a common problem, has always been the focus of attention and research. However, no consistent conclusion has been drawn on its relationship with parental education level. Therefore, this study used meta-analysis and dose-response analysis techniques to explore the overall relationship between the two, and further explore the moderating factors affecting the relationship between the two through subgroup analysis and meta-regression analysis. After a literature search and screening, a total of 22 literatures were included, including 634,821 adolescents aged 9-25, distributed in 10 countries. The results showed that: (1) Overall parental education level was negatively correlated with adolescent depressive symptoms (RR = 0.88. p < 0.001), and there was a dose-response relationship between the two. (2) Geographical location (p = 0.002 < 0.05) and national economic development (p = 0.03 < 0.05) significantly moderated and affected the association between parental education level and adolescent depression, thus presenting a global inconsistency. The results of this study provide a more accurate conclusion on the relationship between parental education and adolescent depression to some extent, highlight the importance and necessity of considering family, economic and cultural factors when studying and solving adolescent depression problems, and guide us to pay more attention to the cross-regional and cross-cultural differences in adolescent depression problems.

School performance and genetic propensities for educational attainment and depression in the etiology of self-harm: a Danish population-based study

BACKGROUND

Poor school performance is linked to higher risks of self-harm. The association might be explained through genetic liabilities for depression or educational attainment. We investigated the association between school performance and self-harm in a population-based sample while assessing the potential influence of polygenic risk scores (PRSs) for depression (PRSMDD) and for educational attainment (PRSEDU).

METHOD

We conducted a follow-up study of individuals born 1987-98 and followed from age 18 until 2016. The total sample consisted of a case group (23,779 diagnosed with mental disorders; schizophrenia, bipolar disorder, depression, autism, and attention deficit hyperactivity disorder (ADHD) and a randomly sampled comparison group (n = 10,925). Genome-wide data were obtained from the Neonatal Screening Biobank and information on school performance, family psychiatric history, and socioeconomic status from national administrative registers.

RESULTS

Individuals in the top PRSMDD decile were at higher self-harm risk in the case group (IRR: 1.30; 95% CI 1.15-1.46), whereas individuals in the top PRSEDU decile were at lower self-harm risk (IRR: 0.63; 95% CI: 0.55-0.74). Poorer school performance was associated with higher self-harm risk in persons diagnosed with any mental disorder (IRR: 1.69; 95% CI: 1.44-1.99) and among the comparison group (IRR: 7.93; 95% CI: 4.47-15.18). Observed effects of PRSMDD and PRSEDU on self-harm risk were strongest for individuals with poor school performance.

CONCLUSION

Associations between PRSMDD and self-harm risk and between PRSEDU and self-harm risk were found. Nevertheless, these polygenic scores seem currently of limited clinical utility for identifying individuals at high self-harm risk.

School-to-work and school-to-university transition and health inequalities among young adults: a scoping review

OBJECTIVES

The main objective was to systematically map evidence regarding the emergence of health inequalities in individuals aged 16-24 years during school-to-work and school-to-university transition (STWT). Second, we aimed to summarise the evidence on potential effects of contextual and compositional characteristics of specific institutional contexts entered during STWT on health and health behaviours.

DESIGN

Scoping review.

STUDY SELECTION

Relevant literature was systematically searched following the methodological framework proposed by Arksey and O'Malley. Ovid MEDLINE and Web of Science, and websites of the International Labour Organization and National Institute for Occupational Safety and Health were searched, using a predetermined search strategy. Articles in English or German published between 1 January 2000 and 3 February 2020 were considered.

DATA EXTRACTION

To collect the main information from the selected studies, a data extraction spreadsheet was created. Data were summarised and grouped into five health outcomes and five institutional contexts (school, vocational training, university, work, unemployment).

RESULTS

A total of 678 articles were screened for inclusion. To be able to draw a picture of the development of various health outcomes over time, we focused on longitudinal studies. Forty-six prospective studies mapping health-related outcomes during STWT were identified. Higher family socioeconomic position (SEP) was associated with higher levels of health behaviour and lower levels of health-damaging behaviour, but there was also some evidence pointing in the opposite direction. Disadvantaged family SEP negatively impacted on mental health and predicted an adverse weight development. There was limited evidence for the outcomes physical/somatic symptoms and self-rated health. Meso-level characteristics of the institutional contexts identified were not systematically assessed, only individual-level factors resulting from an exposure to these contexts, rendering an analysis of effects of contextual and compositional characteristics on health and health behaviours impossible.

CONCLUSIONS

This scoping review demonstrated a wide range of health inequalities during STWT for various health outcomes. However, knowledge on the role of the core institutional contexts regarding the development of health inequalities is limited.

Parental education and youth suicidal behaviours: a systematic review and meta-analysis

AIMS

Lower parental education has been linked to adverse youth mental health outcomes. However, the relationship between parental education and youth suicidal behaviours remains unclear. We explored the association between parental education and youth suicidal ideation and attempts, and examined whether sociocultural contexts moderate such associations.

METHODS

We conducted a systematic review and meta-analysis with a systematic literature search in PubMed, PsycINFO, Medline and Embase from 1900 to December 2020 for studies with participants aged 0-18, and provided quantitative data on the association between parental education and youth suicidal ideation and attempts (death included). Only articles published in English in peer-reviewed journals were considered. Two authors independently assessed eligibility of the articles. One author extracted data [e.g. number of cases and non-cases in each parental education level, effect sizes in forms of odds ratios (ORs) or beta coefficients]. We then calculated pooled ORs using a random-effects model and used moderator analysis to investigate heterogeneity.

RESULTS

We included a total of 59 articles (63 study samples, totalling 2 738 374 subjects) in the meta-analysis. Lower parental education was associated with youth suicidal attempts [OR = 1.12, 95% Confidence Interval (CI) = 1.04-1.21] but not with suicidal ideation (OR = 1.05, 95% CI = 0.98-1.12). Geographical region and country income level moderated the associations. Lower parental education was associated with an increased risk of youth suicidal attempts in Northern America (OR = 1.26, 95% CI = 1.10-1.45), but with a decreased risk in Eastern and South-Eastern Asia (OR = 0.72, 95% CI = 0.54-0.96). An association of lower parental education and increased risk of youth suicidal ideation was present in high- income countries (HICs) (OR = 1.14, 95% CI = 1.05-1.25), and absent in low- and middle-income countries (LMICs) (OR = 0.91, 95% CI = 0.77-1.08).

CONCLUSIONS

The association between youth suicidal behaviours and parental education seems to differ across geographical and economical contexts, suggesting that cultural, psychosocial or biological factors may play a role in explaining this association. Although there was high heterogeneity in the studies reviewed, this evidence suggests that the role of familial sociodemographic characteristics in youth suicidality may not be universal. This highlights the need to consider cultural, as well as familial factors in the clinical assessment and management of youth's suicidal behaviours in our increasingly multicultural societies, as well as in developing prevention and intervention strategies for youth suicide.

The effect of low childhood income on self-harm in young adulthood: Mediation by adolescent mental health, behavioural factors and school performance

Low childhood income is an established risk factor of self-harm in adolescence and young adulthood, and childhood income is additionally associated with various correlates of self-harm. How these correlates, such as psychiatric disorders, substance abuse, violent behaviour and school problems, mediate the effect of childhood income on self-harm, is less understood. The purpose of the current paper is to examine this mediation. The study is based on administrative register data on all Finnish children born in 1990–1995. An analytical sample of 384,121 children is followed from age 8 to 22. We apply the parametric g-formula to study the effect of childhood income on the risk of self-harm in young adulthood. Adolescent psychiatric disorders, substance abuse, prior self-harm, violent criminality and victimization, out-of-home placements, not being in education, employment or training and school performance are considered as potential mediators. We control for confounding factors related to childhood family characteristics. As a hypothetical intervention, we moved those in the lowest childhood income quintile to the second-lowest quintile, which resulted in a 7% reduction in hospital-presenting self-harm in young adulthood among those targeted by the intervention (2% reduction in the total population). 67% of the effect was mediated through the chosen mediators. The results indicate that increases in childhood material resources could protect from self-harm in young adulthood. Moreover, the large proportion of mediation suggests that targeted interventions for high-risk adolescents may be beneficial. To our knowledge, this is the first paper to use the parametric g-formula to study youth self-harm. Future applications are encouraged as the method offers several further opportunities for analysing the complex life course pathways to self-harm.

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We study mediation in the association between low childhood income and self-harm.

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Effects of a hypothetical intervention are examined.

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Most of the effect of low childhood income on the risk of self-harm is indirect.

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Distinct pathways are identified.

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The parametric g-formula offers further avenues for self-harm research.

Binge eating and purging in first-year college students: Prevalence, psychiatric comorbidity, and academic performance

BACKGROUND

Binge eating and purging behaviors (BPB) are common among college students, but evidence is scant on prevalence and associations of BPB with mental health problems and objective academic performance. This study aims to investigate: (a) 12-month prevalence of BPB among college first-year students, (b) comorbidity patterns of BPB with various mental health problems, and (c) the association of BPB with objective academic functioning.

METHODS

Using data from the Leuven College Surveys (Belgium), as part of the World Mental Health Surveys International College Student initiative, we cross-sectionally assessed 12-month BPB and mental health problems among college first-year students (n = 4,889; response rate = 73.2%) at the beginning of the academic year. Objective measures of academic functioning (final grades, expressed in academic year percentage "AYP" [0-100%] and academic failure) were obtained from administrative records at the end of the academic year.

RESULTS

Twelve-month prevalence of BPB was 7.6% (7.3%binge eating and 1.0%purging), with higher rates among females than males. Bivariate models showed an association between BPB and numerous mental health problems (ORs = 3.4-18.4). Multivariate models showed associations with non-suicidal self-injury, post-traumatic stress, internalizing/externalizing problems and suicidal ideation. After controlling for sociodemographic characteristics and comorbid mental health problems, BPB were still associated with lower AYP (-4.1 to -11.2% range) and elevated odds of academic year failure (ORs = 1.4-4.2).

CONCLUSIONS

BPB (especially binge eating) are relatively common and associated with mental health problems, comparatively low academic performance, and higher risk of academic failure among college first-year students. Further study is needed to examine the causal dynamics underlying these associations.

Experience of maternal and paternal adversities in childhood as determinants of self-harm in adolescence and young adulthood

INTRODUCTION

Previous studies suggest that childhood experience of parental adversities increases the risk of subsequent offspring self-harm, but studies on distinct paternal and maternal characteristics are few and it remains unclear how these interact with childhood social position. The study aims to assess whether paternal and maternal adversities have different associations with offspring self-harm in adolescence and young adulthood. Interaction by offspring gender and childhood income are investigated, as well as cumulative effects of multiple adversities.

METHODS

The study uses administrative register data on a 20% random sample of Finnish households with children aged 0-14 years in 2000. We follow children born in 1986-1998 (n=155 855) from their 13th birthday until 2011. Parental substance abuse, psychiatric disorders, criminality and hospitalisations due to interpersonal violence or self-harm are used to predict offspring self-harm with Cox proportional hazards models.

RESULTS

The results show a clear increase in the risk of self-harm among those exposed to maternal or paternal adversities with HRs between 1.5 and 5.4 among boys and 1.7 and 3.9 among girls. The excess risks hold for every measure of maternal and paternal adversities after adjusting for childhood income and parental education. Evidence was found suggesting that low income, accumulation of adversity and female gender may exacerbate the consequences of adversities.

CONCLUSIONS

Our findings suggest that both parents' adversities increase the risk of self-harm and that multiple experiences of parental adversities in childhood are especially harmful, regardless of parent gender. Higher levels of childhood income can protect from the negative consequences of adverse experiences.

Suicidal behaviour among persons with attention-deficit hyperactivity disorder

BACKGROUND

Persons diagnosed with attention-deficit hyperactivity disorder (ADHD) have been found to have an increased risk of suicidal behaviour, but the pathway remains to be thoroughly explored.AimsTo determine whether persons with ADHD are more likely to present with suicidal behaviour (i.e. suicide attempts and deaths by suicide) if they have a comorbid psychiatric disorder.

METHOD

Using nationwide registers covering the entire population of Denmark, this cohort study of 2.9 million individuals followed from 1 January 1995 until 31 December 2014, covers more than 46 million person-years. All persons aged ≥10 years with Danish-born parents were identified and persons with a diagnosis of ADHD were compared with persons without. Incidence rate ratios (IRRs) were calculated by Poisson regression, with adjustments for sociodemographics and parental suicidal behaviour.

RESULTS

Persons with ADHD were followed for 164 113 person-years and 697 suicidal outcomes were observed. This group was found to have an IRR of suicidal behaviour of 4.7 (95% CI, 4.3-5.1) compared with those without ADHD. Persons with ADHD only had a 4.1-fold higher rate (95% CI, 3.5-4.7) when compared with those without any psychiatric diagnoses. For persons with ADHD and comorbid disorders the IRR was higher yet (IRR: 10.4; 95% CI, 9.5-11.4).

CONCLUSIONS

This study underlines the link between ADHD and an elevated rate of suicidal behaviour, which is significantly elevated by comorbid psychiatric disorders. In sum, these results suggest that persons with ADHD and comorbid psychiatric disorders are targets for suicide preventive interventions.Declaration of interestNone.

Association between attempted suicide and academic performance indicators among middle and high school students in Mexico: results from a national survey

BACKGROUND

Students' mental health is associated to academic performance. In high income countries, higher students' grades are related to lower odds of suicidal behaviors, but studies on other indicators of academic performance are more limited, specially in middle income countries.

METHODS

Data from 28,519 middle and high school students selected with multistage clustered sampling in the Mexican National Survey of Student's Drug Use. Using a self-administered questionnaire, lifetime suicidal attempt and four indicators of academic performance were assessed: age inconsistency with grade level, not being a student in the last year, perceived academic performance and number of failed courses. Multiple logistic regression models were used to control for sociodemographic and school characteristics.

RESULTS

The lifetime prevalence of attempted suicide was 3.0% for middle school students and 4.2% for high school students. Among middle school students, statistically adjusted significant associations of suicide attempt with academic performance indicators were: not being a student the year before, worse self-perceived performance and a higher number of failed courses; among high school students, predictors were failed courses and self-perceived academic performance, with ORs of 1.65 and 1.96 for the categories of good and fair/poor respectively, compared to those who reported very good performance.

CONCLUSION

Self-perceived academic performance was the main indicator for suicide in both school levels. Suicide prevention efforts in Mexico's schools should include asking students about the perception they have about their own academic performance.

Socioeconomic position and self-harm among adolescents: a population-based cohort study in Stockholm, Sweden

BACKGROUND

Understanding the association between parental socioeconomic position and self-harm in adolescence is crucial due to its substantial magnitude and associated inequality. Most previous studies have been either of cross-sectional nature or based solely on self-reports or hospital treated self-harm. The aim of this study is to determine the association between parental socioeconomic position and self-harm among adolescents with a specific focus on gender and severity of self-harm.

METHODS

A total of 165,932 adolescents born 1988-1994 who lived in Stockholm at the age of 13 were followed in registers until they turned 18. Self-harm was defined as first time self-harm and severity of self-harm was defined as hospitalized or not. Socioeconomic position was defined by parental education and household income. Cox proportional hazards regression were used to estimate hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

Analyses showed an association between parental socioeconomic position and self-harm. Among adolescents with parents with primary and secondary education compared to tertiary parental education the HR were 1.10 (95% CI 0.97-1.24) and 1.16 (95% CI 1.08-1.25) respectively. Compared to the highest income category, adolescents from the lower income categories were 1.08 (95% CI 0.97-1.22) to 1.19 (95% CI 1.07-1.33) times more likely to self-harm. In gender-stratified analyses, an association was found only among girls. Further, restriction to severe cases eliminated the association.

CONCLUSIONS

This study suggested that low parental socioeconomic position is associated with self-harm in adolescence, predominantly among girls. The desertion of an association among severe cases may be explained by differences in suicidal intent and underlying psychiatric diagnosis. Efforts to prevent self-harm should consider children with low parental socioeconomic position as a potential target group.

Estimating direct effects of parental occupation on Spaniards' health by birth cohort

Background

Social health inequalities in adult population are partly due to socioeconomic circumstances in childhood. A better understanding of how those circumstances affect health during adulthood may improve the opportunities for reducing health disparities. The objective of this study is to investigate the effect of parental socioeconomic status, which is proxied by occupation, on adult Spaniards’ health by birth cohort. The analysis will allow checking not only the direct impact of parental occupation on their offspring’s health, but also whether inherited inequality has been reduced over time.

Methods

We use data from the Bank of Spain’s Survey of Household Finances on Spanish households from 2002 to 2008. Sequential models were used to estimate the influence of the father’s and mother’s occupation on their offspring’s health, trying to disentangle direct from indirect effects. With a sample of 26,832 persons we consider effects for four different cohorts by birth periods ranging from 1916 to 1981.

Results

The results show that parental occupation has a significant direct impact on individuals’ health (p < 0.01). The effect of father’s occupation exceeds that of mother’s. For those born before 1936, the probability of reporting a good health status ranges from 0.31 (95% confidence interval (CI) 0.14–0.48), when fathers were classified as unskilled elementary workers, to 0.98 (95% CI 0.98–0.99) when they were managers or mid-level professionals. For those born during the period 1959–1975, those probabilities are 0.49 (95% CI 0.39–0.59) and 0.97 (95% CI 0.96–0.98), respectively. Therefore, health inequalities linked to parental socioeconomic status have been noticeably reduced, although discrimination against unskilled workers persists over time.

Conclusions

Great progress has been made in the health area during the twentieth century, so that the impact of parental socioeconomic status on individuals’ health has been significantly tempered for those at the bottom of the social scale. However, more efforts focused on the improvement of living conditions for most socioeconomically disadvantaged are needed in order to further reduce social inequalities in health.

Association between adolescent suicide and sociodemographic factors in Chile: cross-sectional ecological study

BACKGROUND

Adolescent suicide rates (ASR) are a matter of concern worldwide. Causes of this trend are not understood and could correspond to socioeconomic factors such as inequality.

AIM

To investigate sociodemographic variables related to ASR, particularly the potential association with indicators of socioeconomic inequality.

METHOD

Cross-sectional ecological study analyzing data from 29 health districts with univariate and multivariable multilevel Poisson models.

RESULTS

ASR were higher in male adolescents and at increasing age. No association was found between ASR and inequality (Gini coefficient and 20/20 ratio). Analysis revealed that living in a single-parent family is associated with ASR.

CONCLUSIONS

The usual demographic patterns of adolescent suicide apply in Chile. An emerging variable of interest is single-parent family. No cross-sectional association between social inequality and ASR was found based on conflicting evidence. These results should be explored in future prospective population studies to further understand associated social factors.

Lifetime and 12-Month Nonsuicidal Self-Injury and Academic Performance in College Freshmen

We examined whether nonsuicidal self-injury (NSSI) is associated with academic performance in college freshmen, using census-based web surveys (N = 7,527; response = 65.4%). NSSI was assessed with items from the Self-Injurious Thoughts and Behaviors Interview and subsequently linked with the administratively recorded academic year percentage (AYP). Freshmen with lifetime and 12-month NSSI showed a reduction in AYP of 3.4% and 5.9%, respectively. The college environment was found to moderate the effect of 12-month NSSI, with more strongly reduced AYPs in departments with higher-than-average mean departmental AYPs. The findings suggest that overall stress and test anxiety are underlying processes between NSSI membership and academic performance.

Does poor school performance cause later psychosocial problems among children in foster care? Evidence from national longitudinal registry data

Research has shown that children in foster care are a high-risk group for adverse economic, social and health related outcomes in young adulthood. Children's poor school performance has been identified as a major risk factor for these poor later life outcomes. Aiming to support the design of effective intervention strategies, this study examines the hypothesized causal effect of foster children's poor school performance on subsequent psychosocial problems, here conceptualized as economic hardship, illicit drug use, and mental health problems, in young adulthood. Using the potential outcomes approach, longitudinal register data on more than 7500 Swedish foster children born 1973-1978 were analyzed by means of doubly robust treatment-effect estimators. The results show that poor school performance has a negative impact on later psychosocial problems net of observed background attributes and potential selection on unobservables, suggesting that the estimated effects allow for causal interpretations. Promotion of school performance may thus be a viable intervention path for policymakers and practitioners interested in improving foster children's overall life chances.

Epidemiology of non-fatal injuries among Egyptian children: a community-based cross-sectional survey

BACKGROUND

Injuries are a major cause of childhood morbidity and mortality worldwide. We aimed to determine the magnitude and characteristics of child injuries in Egypt and to identify the associated risk factors.

METHODS

A community-based, cross-sectional survey was conducted over 27 Egyptian governorates from June to October, 2011. The target population was 1977 households with children aged 0-18 years who had experienced accidental injuries.

RESULTS

In the 6-month period before the investigation, 1576 injuries were reported in 1472 children from a sample population of 1399 households (response rate 70.8 %). Falls (25 %) and burn injuries (20.3 %) were the most common accidental injuries. The incidence of these injuries was significantly higher among boys (57.2 %) than girls and in children aged 2-6 years (70 %) compared with older and younger children. The five main causes of injuries were wounds (30.6 %), fractures (28.7 %), burns (20.3 %), swallowing a foreign body (8.4 %) and accidentally ingesting a poison (7.8 %). Injuries from drowning (n = 27), animal bites (n = 22) and sunstroke (n = 20) mostly occurred in rural children, accounting for 65 %, 54.4 % and 52 %, respectively, of all injuries in rural children. Home and its immediate surroundings (64.4 %) was the most common setting for injuries. Maternal age, education and working status were also associated with childhood injuries (p < 0.05). Children of second and third birth order were at higher risk for injuries (p < 0.0001).

CONCLUSIONS

Childhood injuries account for a substantial healthcare burden in Egypt. Our findings emphasise the importance of developing national preventive programs designed to reduce the incidence of childhood injuries.

Childhood household dysfunction, school performance and psychiatric care utilisation in young adults: a register study of 96 399 individuals in Stockholm County

BACKGROUND

Exposure to childhood household dysfunction increases the risk of psychiatric morbidity. Although school performance also has been linked with psychiatric morbidity, limited research has considered school performance as a mediating factor. To address this gap in the literature, the current register study examined whether school performance mediates the association between childhood household dysfunction (experienced between birth and age 14 years) and psychiatric care utilisation in young adulthood.

METHODS

We used a Swedish cohort of 96 399 individuals born during 1987-1991. Indicators of childhood household dysfunction were familial death, parental substance abuse and psychiatric morbidity, parental somatic disease, parental criminality, parental separation/single-parent household, public assistance recipiency and residential instability. Final school grades from the 9th year of compulsory school were used to create five categories. Estimates of risk of psychiatric care utilisation (measured as inpatient, outpatient and primary care) after the age of 18 years were calculated as HRs with 95% CIs. Mediation was tested with the bootstrap approach.

RESULTS

Cumulative exposure to childhood household dysfunction was positively associated with psychiatric care utilisation. Specifically, individuals exposed to three or more indicators with incomplete school grades had the highest risk (HR=3.7 (95% CI 3.3 to 4.1) after adjusting for demographics), compared to individuals exposed to no indicators with highest grades. School performance was found to mediate the relationship.

CONCLUSIONS

Our findings suggest that future efforts to prevent or mitigate the negative effects of childhood household dysfunction on psychiatric morbidity may benefit from integration of strategies that improve school performance among vulnerable youth.

Parental academic involvement in adolescence as predictor of mental health trajectories over the life course: a prospective population-based cohort study

BACKGROUND

Mental health problems are rising, especially among younger people, indicating a need to identify determinants of the development of mental health over the life course. Parental involvement in their children's studies, particularly in terms of academic socialisation, has been shown to predict better mental health in adulthood, as well as other more favourable health outcomes, but no study published so far has examined its impact on trajectories of mental health. We therefore sought to elucidate the role of parental involvement at age 16 on the life course development of internalised mental health symptoms.

METHODS

In a population-based cohort (452 women and 488 men, 87% of the eligible participants), we examined the association between parental involvement in their offspring's studies, measured by teacher and pupil ratings at age 16, and an index of internalised mental health symptoms at the ages of 16, 18, 21, 30, and 43. Using latent class trajectory analysis, 5 different trajectories were derived from these indices: Very low stable (least symptoms), Low stable, Increasing, Moderate stable, and High decreasing (most symptoms). Multinomial logistic regression was used to regress trajectory membership on the parental involvement variables.

RESULTS

Teacher-rated parental interest in their offspring's studies during the last year of compulsory school was associated with a lower risk of entering the Moderate stable (OR = 0.54; 95% CI 0.30 to 0.98) and High decreasing (OR = 0.41; 0.18 to 0.91) trajectories, compared with the Low stable, also after adjustment for sex, parental social class and mental health, family unemployment and own school grades. Both these associations were present only in children with grades above the national average. Student-rated availability of assistance with homework was associated with a higher chance of entering the Very low stable trajectory in the whole sample (OR = 1.24; 1.07 to 1.43), in men (OR = 1.25; 1.05 to 1.48) and in those with above average grades (OR = 1.39; 1.13 to 1.72), and with a lower risk of entering the Moderate stable in women (OR = 0.74; 0.55 to 0.99), also after the same adjustments.

CONCLUSIONS

Parental involvement in their offspring's studies may buffer against poor mental health in adolescence which may track into adulthood.

Subjective health complaints in older adolescents are related to perceived stress, anxiety and gender - a cross-sectional school study in Northern Sweden

BACKGROUND

Negative trends in adolescent mental and subjective health are a challenge to public health work in Sweden and worldwide. Self-reported mental and subjective health complaints such as pain, sleeping problems, anxiety, and various stress-related problems seem to have increased over time among older adolescents, especially girls. The aim of this study has therefore been to investigate perceived stress, mental and subjective health complaints among older adolescents in Northern Sweden.

METHODS

Data were derived from a cross-sectional school-based survey with a sample consisting of 16-18 year olds (n = 1027), boys and girls, in the first two years of upper secondary school, from different vocational and academic programmes in three public upper secondary schools in a university town in northern Sweden. Prevalence of perceived stress, subjective health complaints, general self-rated health, anxiety, and depression were measured using a questionnaire, including the Hospital Anxiety and Depression Scale (HADS).

RESULTS

A large proportion of both girls and boys reported health complaints and perceived stress. There was a clear gender difference: two to three times as many girls as boys reported subjective health complaints, such as headache, tiredness and sleeping difficulties and musculoskeletal pain, as well as sadness and anxiety. High pressure and demands from school were experienced by 63.6% of girls and 38.5% of boys. Perceived stress in the form of pressure and demands correlated strongly with reported health complaints (r = 0.71) and anxiety (r = 0.71).

CONCLUSIONS

The results indicate that mental and subjective health complaints are prevalent during adolescence, especially in girls, and furthermore, that perceived stress and demands may be important explanatory factors. Future studies should pay attention to the balance between gender-related demands, perceived control and social support, particularly in the school environment, in order to prevent negative strain and stress-related ill-health. The gender gap in subjective adolescent health needs to be further explored.