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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 the 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. 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 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.

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 discri

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.

(1) Background: The World Health Organization recommends active commuting as a source of physical activity. Active commuting is determined by various factors, including the socioeconomic status (SES) of families and neighborhoods, distance to schools, perceived neighborhood safety, lifestyles, and availability of walkways and biking paths. This study aimed to assess factors associated with modes of transportation to and from school among adolescents aged 16–19 living in a middle-sized city in Sweden. (2) Method: Three hundred and fourteen students, of whom 55% were females, from schools in the city of Västerås participated in the study. Printed as well as web-based self-administered questionnaires were used to collect the data. (3) Results: Adolescents living in high SES neighborhoods were 80% more likely to bike or walk to school (OR = 1.80; CI: 1.01, 3.20) than adolescents living in low SES neighborhoods. Furthermore, active commuting was associated with higher consumption of fruits and vegetables (OR = 1.77; CI: 1.05, 2.97) and less consumption of junk foods (OR = 0.43; CI: 0.26, 0.71), as compared to passive commuting. (4) Conclusions: Active commuting is a cost-effective and sustainable source of regular physical activity and should be encouraged at a societal level.

Based on the synthesis of outside versus inside perspectives, this paper weighs the positive attributes of the so-called deprived place against its negative media image. Applying the concept of territorial stigmatization, small-scale citizen science was conducted to gain a unique understanding of the Swedish neighborhood from within. With the United Nations’ Sustainable Development Goal 11 in mind, this approach enables researchers to reach otherwise difficult to access young urban outcasts and probe the potential to overcome their community’s lack of political influence. An overlap between local media narratives and urban outcasts’ perceptions of “drug and crime” and “football and school” was revealed. Yet, this first-generation study also painted a somewhat different picture of the stigmatized neighborhood, supplying new insights about places that matter most for marginalized young males. In this Swedish case, their pictures revealed that the local corner market, football court and youth club act as an antidote for the effects of stigmatization. This Our Voice citizen science initiative proved to be a good measure of two communities’ abilities to withstand stigmatization, which is either tainted by false perceptions from the outside or weakened by crime from within. Finally, attempting to bypass structural discrimination, citizen scientists’ findings and researchers’ conclusions were made available to students, colleagues and guests at a poster presentation hosted by Mälardalen University and to concerned politicians from Eskilstuna City Hall as well as the broader public via a local Swedish television station.

Background: Children with moderate acute malnutrition (MAM) have an increased risk of mortality, infections and impaired physical and cognitive development compared to well-nourished children. In parts of Ethiopia not considered chronically food insecure there are no supplementary feeding programmes (SFPs) for treating MAM. The short-term outcomes of children who have MAM in such areas are not currently described, and there remains an urgent need for evidence-based policy recommendations. Methods: We defined MAM as mid-upper arm circumference (MUAC) of ≥11.0 cm and <12.5 cm with no bilateral pitting oedema to include Ethiopian government and World Health Organisation cut-offs. We prospectively surveyed 884 children aged 6-59 months living with MAM in a rural area of Ethiopia not eligible for a supplementary feeding programme. Weekly home visits were made for seven months (28 weeks), covering the end of peak malnutrition through to the post-harvest period (the most food secure window), collecting anthropometric, socio-demographic and food security data. Results: By the end of the study follow up, 32.5% (287/884) remained with MAM, 9.3% (82/884) experienced at least one episode of SAM (MUAC <11 cm and/or bilateral pitting oedema), and 0.9% (8/884) died. Only 54.2% of the children recovered with no episode of SAM by the end of the study. Of those who developed SAM half still had MAM at the end of the follow up period. The median (interquartile range) time to recovery was 9 (4-15) weeks. Children with the lowest MUAC at enrolment had a significantly higher risk of remaining with MAM and a lower chance of recovering. Conclusions: Children with MAM during the post-harvest season in an area not eligible for SFP experience an extremely high incidence of SAM and a low recovery rate. Not having a targeted nutrition-specific intervention to address MAM in this context places children with MAM at excessive risk of adverse outcomes. Further preventive and curative approach

Introduction: Guinea is the third hardest hit country in the region with 2,806 cases and 1,814 deaths as of January 11, 2015 after Sierra Leone and Liberia respectively. This KAP study was conducted in three sub-prefectures of Kouroussa in the Kankan region of Guinea from 15 December 2014 to 15 January 2015. It was conducted with the general objective of examining the knowledge, attitude and practice related to Ebola prevention and care among the public of Kouroussa Prefecture. Methods: a cross-sectional study design was employed to collect quantitative data to examine knowledge, attitude and practice related to Ebola. Structured questionnaire was administered by trained data collectors who were supervised by doctors and epidemiologists from WHO and Africa Union. Data were collected from 358 individuals (93% response rate) and analyzed in STATA 13 while tables and graphs are used to display results. Results: over 96% of the respondents have ever heard about Ebola while only 76.2% believed the disease existed in Kouroussa. Avoiding physical contacts including hand shaking and contacts with body fluids, and early treatment of persons sick from Ebola were the two important prevention methods frequently mentioned (96.8% and 93.9%). Only 35.7% of respondents were found to have comprehensive knowledge about Ebola (composite of correctly accepting three methods of prevention (85%) and rejecting misconceptions (55.7%)). Conclusion: the high level of knowledge about modes of transmission and prevention methods has not positively affected the level of comprehensive knowledge about Ebola. In contrast, the prevailing high level of misconceptions surrounding Ebola was found to be responsible for a low comprehensive knowledge.

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 predicti