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Pettersson, R., Strandh, M. & Lucas, S. (2025). Violence in adulthood amplifies the health correlates of childhood maltreatment. BMC Public Health, 25(1), Article ID 1193.
Open this publication in new window or tab >>Violence in adulthood amplifies the health correlates of childhood maltreatment
2025 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 25, no 1, article id 1193Article in journal (Refereed) Published
Abstract [en]

Background: Although experiences of violence are detrimental and may occur throughout the lifespan, few studies have examined the long-term health correlates of violence in both childhood and adulthood. Objective: To examine the association of exposure to child maltreatment (CM) as well as severe violence in adulthood with mental and physical health problems and health-related risk behaviors in adulthood.

Methods: The study was cross-sectional and applied a novel survey instrument among a random sample of 10 337 Swedish women and men aged 18–74. Logistic regression was applied to calculate odds ratios.

Results: Exposure to 0, 1, 2 or 3 or more types of CM showed graded associations for depression, anxiety, self-harm and PTSD in adulthood. Irritable bowel syndrome, fibromyalgia and obesity showed modest correlations. No significant associations were found between CM and ischemic heart disease (IHD), type 2 diabetes or cancer, although the ORs were in line with several previous ACE studies. When exposure to severe violence in adulthood was added to CM, odds ratios increased dramatically for mental health problems and health-related risk behaviors, suggesting that revictimization may moderate or mediate this relationship.

Conclusions: The results underscore the importance of studying violence exposure in a life-course perspective and suggest that the relationship between childhood adversities and long-term physical health problems in adulthood may be affected by the traumatic effects of revictimization in adult life. This points to the importance of early identification of child maltreatment and provision of robust services to protect children, treat symtoms of trauma, and enhance resilience to decrease the risk of poor health outcomes.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2025
Keywords
Adverse childhood experiences, Exposure to violence, Health-related risk behavior, Life-course, Mental health, Physical health, Poly-victimization, Revictimization
National Category
Epidemiology Public Health, Global Health and Social Medicine Social Work
Identifiers
urn:nbn:se:umu:diva-237385 (URN)10.1186/s12889-025-22469-x (DOI)001456231000008 ()40158129 (PubMedID)2-s2.0-105001383439 (Scopus ID)
Funder
The Swedish Crime Victim Compensation and Support Authority
Available from: 2025-04-22 Created: 2025-04-22 Last updated: 2025-04-22Bibliographically approved
Högberg, B., Strandh, M., Petersen, S. & Nilsson, K. (2024). Associations between academic achievement and internalizing disorders in Swedish students aged 16 years between 1990 and 2018. European Child and Adolescent Psychiatry
Open this publication in new window or tab >>Associations between academic achievement and internalizing disorders in Swedish students aged 16 years between 1990 and 2018
2024 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Rising rates of internalizing disorders and rising rates of school failure among adolescents are growing concerns. Despite the strong association between academic achievement and internalizing disorders, possible links between these two trends have not been investigated. Thus, the aim of this study was to investigate the development of the cross-sectional associations between academic achievement and internalizing disorders in Swedish students aged 16 years between 1990 and 2018.

Methods: Register data on specialist psychiatric care and prescriptions of psycholeptic and psychotropic drugs were linked to data on students’ school grades in the last year of compulsory school. The total sample size was 3,089,674 students. Logistic regression models with internalizing disorders as the dependent variable, and graduation year and academic achievement as independent variables, were estimated.

Results: Throughout the period, there was a strong negative association between academic achievement and internalizing disorders. Low-achieving students had by far the highest risks of internalizing disorders. In absolute terms, the increase in internalizing disorders was clearly largest for low-achieving students. The relative risks for low-achieving compared to higher achieving students increased between 1990 and 2010 and declined after 2010.

Conclusions: This study found consistently large, and at least until 2010 growing, achievement-related inequalities in internalizing disorders among Swedish adolescents between 1990 and 2018, with the lowest achieving students having disproportionally high risks. The increasingly pronounced concentration of internalizing disorders in the lowest rungs of the achievement distribution suggests that preventive interventions should focus on supporting this doubly disadvantaged group of students.

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
School performance, Grade point average, School failure, Anxiety disorders, Mood disorders, Temporal trends
National Category
Public Health, Global Health and Social Medicine
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-231263 (URN)10.1007/s00787-024-02597-2 (DOI)001344752500001 ()39470790 (PubMedID)2-s2.0-85207966365 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-01062
Note

Updated version. 

Author correction: Högberg, B., Strandh, M., Petersen, S. et al. Correction: Associations between academic achievement and internalizing disorders in Swedish students aged 16 years between 1990 and 2018. Eur Child Adolesc Psychiatry (2024). DOI: 10.1007/s00787-024-02617-1

Available from: 2024-10-30 Created: 2024-10-30 Last updated: 2025-02-20
Högberg, B., Strandh, M. & Petersen, S. (2024). Changes in the association between educational achievement, attainment and subsequent mental health: a survival analysis of 21 Swedish graduation cohorts. BMC Public Health, 24(1), Article ID 3016.
Open this publication in new window or tab >>Changes in the association between educational achievement, attainment and subsequent mental health: a survival analysis of 21 Swedish graduation cohorts
2024 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, no 1, article id 3016Article in journal (Refereed) Published
Abstract [en]

Background: Low academic achievement and low educational attainment in adolescence is associated with higher risks of internalizing disorders later in life. However, less is known regarding if these associations vary over time across cohorts. The aim of this study was to investigate temporal changes in the association between academic achievement or educational attainment and subsequent inpatient treatment for internalizing disorders among Swedish youths.

Methods: Register data on all students graduating from compulsory school in Sweden between 1990 and 2010 (N = 2 252 703) were used. Students were followed for a maximum of 8 years using discrete time proportional hazard models. Internalized disorders were measured by specialized inpatient psychiatric care for depression or anxiety disorders. Academic achievement was measured by grades at the end of compulsory school, and educational attainment by completion of upper secondary school.

Results: The positive association between inpatient treatment for internalizing disorders and both low compulsory school achievement and non-completion of upper secondary school became stronger in more recent cohorts. The results were completely driven by girls and native-born youth.

Conclusions: Low compulsory school achievements and failure to complete upper secondary school has become more important risk factors for inpatient treatment for internalizing disorders, particularly in native-born youth and girls. More research is needed to establish whether youth with internalizing disorders increasingly fail in school or whether low achievement has become more harmful for mental health.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Education, Internalizing conditions, Internalizing disorders, Performance, School, Temporal trends
National Category
Public Health, Global Health and Social Medicine
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-231341 (URN)10.1186/s12889-024-20554-1 (DOI)001346302800007 ()39482614 (PubMedID)2-s2.0-85208291578 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-01062
Available from: 2024-11-01 Created: 2024-11-01 Last updated: 2025-02-20Bibliographically approved
Cashman, M. R., Strandh, M. & Högberg, B. (2024). Does fear-of-failure mediate the relationship between educational expectations and stress-related complaints among Swedish adolescents?: A structural equation modelling approach. European Journal of Public Health, 34(1), 101-106
Open this publication in new window or tab >>Does fear-of-failure mediate the relationship between educational expectations and stress-related complaints among Swedish adolescents?: A structural equation modelling approach
2024 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 34, no 1, p. 101-106Article in journal (Refereed) Published
Abstract [en]

Background: This study investigated the possible mediating role of fear-of-failure between educational expectations and adolescent stress-related complaints with a specific focus on gender differences among Swedishadolescents, and related these findings more broadly to school-related demands and stress-related complaints.

Methods: A total of N¼ 5504 Swedish adolescents (Mage¼ 15 years, SD ¼ 0.0 years, 50.2% girls) were drawn from the2018 Swedish Programme for International Student Assessment study for our investigation. We used structural equation models to explore if fear-of-failure mediates the relationship between educational expectations and negativeaffect, with a specific focus on gender differences. Educational expectations were utilized in the measurement model.Fear-of-failure was constructed as a latent mediating variable. Negative affect was constructed as a latent variableand utilized as an outcome variable. We subsequently undertook bootstrapping tests of indirect effects and nonlinear comparisons of indirect effects to assess the reliability of the results.

Results: Fear-of-failure partially mediatedthe association between educational expectations and negative affect (39%). Our gender-specific structural equation model demonstrated that this relationship was more pronounced for girls, suggesting girls are more vulnerable to negative affect as a result of experiencing higher levels of fear of failing.

Conclusions: The findingssuggest that fear-of-failure partially explains the association between educational expectations and negativeaffect and that this association is more pronounced for girls. This study provides insights into better understanding adolescent stress-related complaints, and the differential role fear of failing has in regards to gender.

Place, publisher, year, edition, pages
Oxford University Press, 2024
National Category
Social Work Public Health, Global Health and Social Medicine
Research subject
Public health; Psychology; Sociology; Social Medicine; educational work
Identifiers
urn:nbn:se:umu:diva-216812 (URN)10.1093/eurpub/ckad200 (DOI)001102263800001 ()37968234 (PubMedID)2-s2.0-85183961814 (Scopus ID)
Funder
Swedish Research Council, 2018-03870_3Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-01062
Available from: 2023-11-16 Created: 2023-11-16 Last updated: 2025-02-20Bibliographically approved
Noland, E., Virtanen, S., Klötz Logan, F., Chang, Z. & Strandh, M. (2024). Post-discharge pharmacological treatment discontinuation of forensic psychiatric patients in Sweden. Frontiers in Psychiatry, 15, Article ID 1342722.
Open this publication in new window or tab >>Post-discharge pharmacological treatment discontinuation of forensic psychiatric patients in Sweden
Show others...
2024 (English)In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 15, article id 1342722Article in journal (Refereed) Published
Abstract [en]

Introduction: Most forensic psychiatric patients have chronic psychiatric disorders that require long-term pharmacological treatment even after discharge from care. However, the prevalence and correlates of post-discharge medication discontinuation in this patient group remain unclear.

Objective: The aim of this study was to investigate the prevalence and correlates of post-discharge discontinuation of pharmacological treatment in forensic psychiatric patients in Sweden.

Methods: Data on individuals discharged from forensic psychiatric care between 2009 and 2018 (n = 1,142) with ongoing pharmacological treatment at the time of discharge (n = 856) were identified from the Swedish National Forensic Psychiatric Register. Cox regression models were used to estimate the association between patient characteristics and medication discontinuation.

Results: Of the 856 individuals with pharmacological treatment at discharge, 488 (57%) discontinued treatment within 2 years of discharge. Factors associated with an increased risk of treatment discontinuation varied between different types of psychotropic medications: the most important correlate was comorbidity between psychosis and personality disorder. Higher age at discharge, longer length of stay, having a history of several psychiatric care episodes, having a trustee, having a limited guardian, and a residing in a supported living accommodation at the time of discharge were associated with a decreased rate of medication discontinuation. This applied for antipsychotics, antidepressants, antiepileptics, and any psychotropic medication, but not for psychostimulants or drugs used in addictive disorders.

Conclusion: For many former forensic psychiatric patients, there are situational factors associated with medication discontinuation. This insight holds significance for professionals who are involved in pre-discharge planning within forensic psychiatric care and those who interact with this cohort of former patients post-discharge.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2024
Keywords
discharge, forensic psychiatry, medication discontinuation, mentally disordered offender, pharmacological treatment discontinuation, psychotropic medications
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-221667 (URN)10.3389/fpsyt.2024.1342722 (DOI)001167486500001 ()38404465 (PubMedID)2-s2.0-85185502699 (Scopus ID)
Funder
Swedish Research Council, 2021-06370
Available from: 2024-03-01 Created: 2024-03-01 Last updated: 2025-04-24Bibliographically approved
Högberg, B. & Strandh, M. (2024). Temporal trends and inequalities in school-related stress in three cohorts in compulsory school in Sweden. Scandinavian Journal of Educational Research
Open this publication in new window or tab >>Temporal trends and inequalities in school-related stress in three cohorts in compulsory school in Sweden
2024 (English)In: Scandinavian Journal of Educational Research, ISSN 0031-3831, E-ISSN 1470-1170Article in journal (Refereed) Epub ahead of print
Abstract [en]

School stress is widespread among students’ worldwide, impacting academic success and mental health. Most research focuses on average stress levels but lacks insights into temporal trends and inequalities. Using repeated longitudinal survey data on 33,000 students in Swedish compulsory school from the Evaluation Through Follow-up (ETF) study, we investigate temporal trends in stress across three cohorts of students (born 1992, 1998, and 2004), with a focus on inequalities by school year, sex, socio-economic status, migration background, school grades, and school difficulties. The results show that (1) stress increased more in year 6 than in year 9 in recent cohorts; (2) stress increased more for girls than for boys; and (3) low school grades and school difficulties have become stronger risk factors for stress. We discuss the findings in the context of recent educational reforms and broader societal trends concerning the role of education for young people’s prospects in life.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2024
Keywords
Mental health, well-being, academic stress, disparities, secular trends, performance, special education needs
National Category
Educational Sciences
Identifiers
urn:nbn:se:umu:diva-222542 (URN)10.1080/00313831.2024.2330932 (DOI)001189424100001 ()2-s2.0-85188624830 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-01062
Available from: 2024-03-20 Created: 2024-03-20 Last updated: 2024-06-05
Pettersson, R., Strandh, M. & Lucas, S. (2024). Women and men physically abused by closely related perpetrators over a lifespan. Revictimization and associations to situational factors in childhood. Children and youth services review, 167, Article ID 107994.
Open this publication in new window or tab >>Women and men physically abused by closely related perpetrators over a lifespan. Revictimization and associations to situational factors in childhood
2024 (English)In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 167, article id 107994Article in journal (Refereed) Published
Abstract [en]

Background: Physical revictimization has been sparsely examined, and in particular the risk of revictimization within the context of closely related perpetrators. Objective: To elucidate the relative contributions of exposure to physical violence in childhood and in youth by perpetrators close to the victim and situational factors in childhood to the risk of physical IPV in adulthood against the social-ecological background of the Trauma-Informed Theory of Individual Health Behavior (TTB). Trust was used as a proxy for resilience.

Participants and setting: A representative sample of 10,337 women and men aged 18–74 in Sweden. Methods: A combined online and postal survey was used. Attrition bias was adjusted for by a calibration and weighting procedure based on official register information. Logistic regression was applied to calculate odds ratios (OR).

Results: Physical abuse by a parent before the age of 15 was associated with approximately 2–3 fold increased odds of physical adult partner violence. The strongest correlation applied to victimization by a partner at age 15–17, where the risk for men was three times that for women. Dysfunctional family conditions and social risk behaviors in adolescence were also associated with adult IPV, while sociodemographic variables had no explanatory value.

Conclusions: Our results indicated that exposure to physical violence by perpetrators close to the victim was the most potent risk factor for exposure to physical IPV in adulthood and that exposure at multiple ages increased this risk. Trust was clearly associated with lower odds of revictimization. Our findings support the tenets of TTB and suggest that they may be extended to the concept of revictimization.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Adult physical abuse, Adverse childhood experiences, Child physical abuse, Intimate partner violence, Life-course, Revictimization
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-232157 (URN)10.1016/j.childyouth.2024.107994 (DOI)001359772600001 ()2-s2.0-85209067688 (Scopus ID)
Funder
The Swedish Crime Victim Compensation and Support Authority, 04647/2014
Available from: 2024-12-04 Created: 2024-12-04 Last updated: 2024-12-04Bibliographically approved
Cashman, M., Strandh, M. & Högberg, B. (2023). Have performance-based educational reforms increased adolescent school-pressure in Sweden?: A synthetic control approach. International Journal of Educational Development, 103, Article ID 102922.
Open this publication in new window or tab >>Have performance-based educational reforms increased adolescent school-pressure in Sweden?: A synthetic control approach
2023 (English)In: International Journal of Educational Development, ISSN 0738-0593, E-ISSN 1873-4871, Vol. 103, article id 102922Article in journal (Refereed) Published
Abstract [en]

Increased levels of stress and other mental health problems have been reported among adolescents in high-income countries. In particular, rates of school pressure have increased significantly. Despite such increases, little is known about the underlying determinants of increased adolescent stress, making this an emerging public health concern. The educational stressors hypothesis contends that increased rates of stress result from pronounced performance pressures placed on adolescents resulting from educational policy initiatives which emphasize academic goal attainment. The present study tests this hypothesis using a synthetic control method and panel data techniques to analyze data from the Health Behavior in School-aged children (HBSC) survey, including more than 150,000 adolescents per survey wave in 25 European countries over 16 years, to assess if the Swedish Educational reforms implemented in the 2011–13 period were associated with increased self-reported school pressure. These reforms implemented increased summative assessments, new grading systems and increased eligibility criteria in accessing further education. Results demonstrate that following the reforms, Swedish adolescents experienced greater levels of school-pressure and led to a greater gender difference in experienced school-pressure where girls were relatively more affected. We conclude that, consistent with the educational stressors hypothesis, the educational reforms have likely contributed to increasing levels of school-pressure for Swedish adolescents.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Adolescent stress, School stress, Education, Educational policy, Educational stressors hypothesis, Cross-country comparative, Synthetic control, Gender differences
National Category
Social Work
Research subject
Social Medicine
Identifiers
urn:nbn:se:umu:diva-216711 (URN)10.1016/j.ijedudev.2023.102922 (DOI)001112368300001 ()2-s2.0-85176240362 (Scopus ID)
Funder
Swedish Research Council, 2018-03870Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-01062
Available from: 2023-11-15 Created: 2023-11-15 Last updated: 2025-04-24Bibliographically approved
Högberg, B., Strandh, M., Johansson, K. & Petersen, S. (2023). Trends in adolescent psychosomatic complaints: a quantile regression analysis of Swedish HBSC data 1985–2017. Scandinavian Journal of Public Health, 51, 619-624
Open this publication in new window or tab >>Trends in adolescent psychosomatic complaints: a quantile regression analysis of Swedish HBSC data 1985–2017
2023 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 51, p. 619-624Article in journal (Refereed) Published
Abstract [en]

Background and aims: According to recent criticism, survey-based measures of adolescent psychosomatic complaints have poor content validity insofar as they conflate trivial with severe complaints. It is argued that this means that estimates of prevalence and trends in complaints may reflect trivial complaints that are not indicators of health problems. In this study, two observable implications of this criticism were investigated: (a) that self-reported psychosomatic complaints should have a bimodal distribution; and (b) that the increase in complaints over time should be of approximately equal size throughout the distribution of complaints.

Methods: Three decades (1985/1986–2017/2018) of repeated cross-sectional data from the Swedish Health Behaviour in School-aged Children survey were used. Psychosomatic complaints were measured using the screening instrument Health Behaviour in School-aged Children symptom checklist. Histograms, bar charts and quantile regression models were used for the analysis.

Results and conclusions: With regard to the first implication, the results showed that the distribution of complaints was not bimodal and that there were no clusters of respondents. This suggests that binary categorisations of students can be reductive and conceal important variations across students. With regard to the second implication, the results showed that the increase in complaints was greatest among students who report frequent and co-occurring complaints. This suggests that reports of increasing complaints in adolescents cannot be explained as being primarily due to a greater inclination to report trivial complaints. It is concluded that any conflation of trivial and more severe complaints in surveys of psychosomatic complaints is not reflected in population-based estimates.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
Adolescents, children, health complaints, psychosomatic, mental health, temporal trends, HBSC, Sweden
National Category
Public Health, Global Health and Social Medicine
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-194508 (URN)10.1177/14034948221094497 (DOI)000796285200001 ()2-s2.0-85132638212 (Scopus ID)
Funder
Swedish Research Council, 2018–03870_3Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00048
Available from: 2022-05-08 Created: 2022-05-08 Last updated: 2025-02-20Bibliographically approved
Noland, E., Klötz Logan, F., Sjöström, S. & Strandh, M. (2023). What happens after forensic psychiatric care?: A latent class analysis of dimensions of welfare for former forensic psychiatric patients. BMC Psychiatry, 23(1), Article ID 937.
Open this publication in new window or tab >>What happens after forensic psychiatric care?: A latent class analysis of dimensions of welfare for former forensic psychiatric patients
2023 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 23, no 1, article id 937Article in journal (Refereed) Published
Abstract [en]

Background: Mentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions.

Methods: Included were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009–2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership.

Results: The results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors.

Conclusions: This study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Criminal recidivism, Forensic psychiatry, Latent class analysis, Level of living, Life situation, Mentally disordered offender, Post-discharge, Welfare dimensions
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-218304 (URN)10.1186/s12888-023-05428-x (DOI)001127107400001 ()38087234 (PubMedID)2-s2.0-85179356735 (Scopus ID)
Available from: 2023-12-22 Created: 2023-12-22 Last updated: 2025-04-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6867-6205

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