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Sociale forskelle i sundhed og trivsel kommer til udtryk i de helt tidlige år i barndom- men, og disse forskelle følger ofte børnene videre i livet og forstærkes af ulighed i skolegang, i uddannelse og i tilknytning til arbejdsmarkedet. Sundhedsstyrelsen har i 2020 sat fokus på ulighed i sundhed gennem rapporterne ”Social ulighed i sundhed og sygdom i Danmark” og ”Indsatser mod ulighed i sundhed”. Denne rapport fortsætter dette fokus på social ulighed i sundhed ved at give indsigt i teoretiske forståelser af de veje, der kan føre til social ulighed i børn og unges sundhed belyst med danske empiriske eksempler. Formålet med rapporten er at give en større forståelse af hvad, der kan føre til social ulighed i sundhed blandt børn og unge for at få indsigt i, hvor der mest hensigtsmæssigt kan sættes ind mod denne ulighed. Med ’Sundhed for alle’ som mission vil Sundhedsstyrelsen gerne bidrage med analy- ser, forklaringer og løsninger på det problem, at nogle grupper i befolkningen får mere sygdom, bliver tidligere syge, mærker større konsekvenser af sygdom og dør tidligere. Hvis vi skal gøre noget ved denne ulighed, kræver det betydelig indsats på mange politikområder (Health in all policies) med inddragelse af politiske beslutningstagere, offentlige myndigheder, private erhverv og civilsamfundet. I sundhedsvæsenet kan vi gøre vores del til at bidrage til mere lighed i sundhed – men vi kan også pege på, hvor- dan social ulighed i sundhed går hånd i hånd med udfordringer og løsninger inden for andre fagområder. ”Veje til social ulighed i sundhed blandt børn og unge” er blevet til på baggrund af et stort arbejde med gennemgang af teoretiske forklaringer og danske empiriske ek- sempler, der viser social ulighed i sundhed blandt børn og unge. Jeg vil gerne takke forskere på Statens Institut for Folkesundhed, SDU, der har udarbejdet denne rapport for Sundhedsstyrelsen. Ligeledes vil jeg

Forskning om utvecklingen av ungdomars psykiska hälsa är utmanande. Begreppets mångsidighet gör vetenskapsteoretiska och metodologiska reflektioner nödvändiga. Data ska samlas in som kan ge möjlighet att följa utvecklingen över tid, vilket kräver goda mätinstrument, god infrastruktur för datainsamling och kompetens att mäta och analysera. Det är en paradox att den självrapporterade psykiska hälsan försämras särskilt hos tonårsflickor i ett land som välfärdslandet Sverige. En översikt ges av tidigare forskning kring trender i ungdomars psykiska hälsa inom ramen för studien Skolbarns hälsovanor. Ytterligare multidisciplinär forskning med olika komplementande ansatser behövs för att bättre fylla kunskapsluckorna., Research on the development of adolescent mental health is challenging. The complexity of the phenomenon makes scientific and methodological reflections necessary. Data must be collected enhancing analysis of the developments over time, which requires good measuring instruments, infrastructure for data collection and competence in analysing and reporting. It is aparadox that the self-reported mental health deteriorates, especially among teenage girls in the Swedish welfare state. Previous research on trends in young people’s mental health in the Health Behaviour in School-aged Children study is reviewed. Further multidisciplinary research with different complementary approaches is needed to better fill the knowledge gaps., Positive Mental Health among School-children in the Nordic Countries

Adolescence is an important developmental period. Young people face many pressures and challenges, including growing academic expectations, changing social relationships with family and peers, and the physical and emotional changes associated with maturation. Mental health is a broad concept, including positive mental health, mental health problems and psychiatric diseases. This introductory paper addresses the issue of positive mental health, and how existing data from the Health Behaviour in School-aged Children study (HBSC) may be used to deepen our knowledge of developments in mental health among adolescents in the Nordic countries. The Health Behaviour in School-Aged Children study is a WHO collaborative cross-national study that now includes 48 countries, collecting data every four years from 1984 to 2018 on health, well-being, health behaviour and social environments. Data collection is carried out in school classes via self-completion of questionnaires. An asset of the study is that the HBSC focuses on understanding young people’s health in their social context at family, peer, school, neighbourhood, and country levels. The investment in the HBSC study gives unique opportunities for high-quality research and monitoring in the Nordic countries. The on-going Nordic research collaboration on positive mental health among adolescents uses the HBSC study as the research infrastructure for analysing trends as well as collecting new data on positive mental health. This special issue reports on trends when positive perspectives have been guiding the analysis of available data. The present research explores the potential of Nordic collaboration and comparative studies of school-aged children in the Nordic countries.

Associations between school-related stress and poor health, risk behaviours and low well-being are well documented. The aim of this paper was to estimate trends of perceived school stress experienced by boys and girls of different ages in the Nordic countries, and to describe trends in school stress between the Nordic countries. Nordic data from the Health Behaviour in School-aged Children study (HBSC) between 2002 and 2014 were used. The participants were aged 11–16 years. School stress was measured by a single item; "How pressured do you feel by schoolwork?" The participants answering "some" or "a lot" were categorised as reporting school stress. Sweden, Norway and Denmark had lower prevalence of school stress compared to Finland and Iceland. There was an increase in Iceland, Finland and Denmark, whereas adolescents from Sweden showed a decreasing trend. In Norway, the level was stable. Boys showed a marginal decline in school stress whereas girls showed an increase, and school stress increased by age for the whole period. It is a challenge for the public education systems in the Nordic countries to develop policies and practices that provide children with the necessary tools to achieve knowledge and skill, and at the same minimise stress in school.

Life satisfaction is an important indicator when assessing positive mental health aspects in populations, including among adolescents. The aim of this study was to investigate trends over time in prevalence of high life satisfaction among adolescents from five Nordic countries: Denmark, Iceland, Finland, Norway and Sweden. We used data from four waves of the Health Behaviour in School-Aged Children study from 2002, 2006, 2010 and 2014 (n=109,847). HBSC is a school-based study examining social circumstances, health and health behaviour among 11-, 13- and 15-years olds every four years in many European and North American countries. The Cantril Ladder, an 11-step visual analogue scale, was used as the measure of life satisfaction, and was dichotomised into two groups: high life satisfaction (scoring 9 or 10 on the scale) and medium/low life satisfaction (scoring <9). Over the 12-year period studied, between 28.6 and 44.8% of adolescents in the five countries rated their life satisfaction as high. Relatively large changes in prevalence levels occurred at the country level over the period. Denmark and Finland showed a steady, significant decline in the prevalence of high life satisfaction over the years. Iceland showed the highest prevalence in 2010. Norway and Sweden showed similar development until 2010, followed by a clear increase for Norway and a sharp decline in adolescent high life satisfaction for Sweden up until 2014. In all countries, high life satisfaction was most prevalent in 11-year- olds and least prevalent in almost all surveys among 15-year-old girls.

The positive mental health and well-being perspective represents innovative public health research of first-rank priority in Europe. Good mental health is both a state and a resource for everyday life. Hence, the concept often refers to a subjective feeling (hedonic component) as well as positive functioning (eudaimonic component). Different conceptualisations of mental health-related issues are a background to this paper, which gives a brief overview of three research issues in the Nordic countries. First, the development in the occurrences of adolescent mental health-related indicators such as life satisfaction, health, sleep, and school pressure. Second, review of Nordic methodological studies reporting on different mental health-related measures. Third, the selection of measures of positive mental health employed in the 2017–2018 Health Behaviour among School-aged Children (HBSC) data collection in the Nordic countries. Using the Nordic HBSC data for 2002–2014, it was found that symptom and problem-oriented analyses of mental health can improve our understanding of the challenges adolescents face. However, there is also a need to examine positive aspects of mental health in order to enhance our understanding of different mental health-related dimensions. New measures were included in the 2017–18 HBSC data collection in the Nordic countries, enabling researchers to answer different research questions including analysing factors mediating and moderating positive mental health among school-aged children. Extending the perspective from a symptom- and problem-oriented view to a more positive and asset-based perspective adds additional value to studies of mental health.