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Background: Recent findings indicate that the association between academic achievement and internalizing mental health problems or disorders has become stronger over time. It is not known if this change has been driven by specific subgroups of students. The aim of this paper was to investigate temporal changes between 2006 and 2018 in the association between academic achievement and internalizing disorders among Swedish school year 9 students (aged 16 years) across subgroups defined by students' sex, socio-economic status, and country of birth.

Methods: Register data on all students (N = 1,422,487) graduating from the last year of Swedish compulsory school (school year 9) between 2006 and 2018 were used in the analyses. Achievement was measured by students' final grade point average, and internalizing disorders were measured using data on treatment for anxiety or mood disorders. Logistic regression models were used to test for multiplicative interaction, and marginal effects for additive interaction, between achievement and time. Models were fitted separately for subgroups defined by sex, socio-economic status, and country of birth.

Results: The association between achievement and treatment for internalizing disorders became stronger over time among Swedish-born students but was largely stable (in absolute terms) or diminished (in relative terms) among immigrant students. Among Swedish-born students, the largest increase in treatment for internalizing disorders was observed in low-achieving girls. Differences in trends depending on socio-economic status were more mixed.

Conclusions: Low-achieving students and girls face multiple disadvantages in life. The disproportionate increase in internalizing disorders among low-achieving students, and especially low-achieving girls, is concerning from the perspective of equity in health.

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.

Background: This study aimed to identify distinct patterns of teaching practices in Swedish compulsory schools and their influence on adolescents’ subjective well-being, focusing on school satisfaction and stress. We differentiated among teacher-centered, student-centered, and student-dominated practices using a person-oriented approach.

Methods: Data were drawn from a nationally representative sample of 9th-grade students in the Swedish Evaluation through Follow-Up Survey. Latent class analysis identified teaching practice subtypes based on student perceptions, and linear regressions assessed differences in subjective well-being across these subtypes.

Results: Three distinct classes emerged: student-centered, student-dominated, and teacher-centered practices. Student-centered practices correlated with moderate school satisfaction, while student-dominated practices showed the highest satisfaction but increased stress. Teacher-centered practices resulted in the lowest satisfaction among the classes.

Discussion: Findings indicate that student-centered and student-dominated practices likely enhance subjective well-being, though overly autonomous settings may increase stress, underscoring the need for balanced instructional approaches.

Aims: This study examined the association between educational attainment and the risk of deaths of despair among individuals assessed for substance use severity at municipal social services in Sweden. It aimed to determine whether the protective association between education and despair-related mortality risk, commonly observed in broader population studies, also applies to this high-risk, treatment-seeking population.

Methods: We linked data from municipal Addiction Severity Index (ASI) assessments to various population registers. The study population included adults aged 25 years or older who were assessed for substance use severity between 1999 and 2019. Fine–Gray competing risk regression models were employed to examine the association between educational attainment and despair-related mortality, both overall and by subtype (alcohol-related, drug use-related, suicide).

Results: Tertiary education was unexpectedly associated with increased risks of overall despair-related mortality, alcohol-related and drug use-related mortality, after controlling for demographic characteristics, ASI composite scores and substance use onset age. No significant associations were found between education and suicide.

Conclusions: The counterintuitive finding that tertiary education is linked to a greater risk of despair-related mortality among social service users may be attributed to differences between the treatment-seeking population and the general population. Highly educated individuals who seek treatment from municipal social services might have severe substance use and complex psychosocial problems and/or contact social services after exhausting other treatment options. Further research is necessary to understand how educational and socioeconomic factors influence treatment pathways for individuals with severe substance use problems in Sweden and how these different pathways impact health-related outcomes.

While men frequently experience interpersonal violence, their help-seeking behaviors and experiences with support services remain understudied. Moreover, existing research has largely focused on male victims abused by an intimate partner, overlooking other types of close relationships, such as with family members and caregivers, that may be particularly salient from an intersectional perspective. This study examined variations in help-seeking patterns and social service support among male victims of interpersonal violence in Sweden depending on age, disability status, and migration background. To this end, we used register data on all male clients (N = 189) seeking support for interpersonal violence from the social services in 34 Swedish municipalities. Logistic and Poisson regression models were fitted to analyze intersectional differences in perpetrator characteristics, contact initiation, inter-organizational collaboration, and the type and amount of support received. Results showed that typically marginalized groups – old and young victims and victims with disabilities – were generally more often victimized by perpetrators other than a partner, more often referred to the social services by other organizations, received more support, and their cases resulted in more collaborations. This indicates that, among male victims of interpersonal violence, those victimized by family members or other close relations besides intimate partners are often the most vulnerable. Our findings highlight the importance of an encompassing understanding of interpersonal violence that includes multiple types of perpetrators, especially in the context of intersectional analyses. They also underline that interpersonal violence among men is often part of a broader web of social or health-related problems, and that organizational responses to male victims cannot be understood without taking this broader web into account.

Background: A recent review of research on the association between school-related stress and internalizing problems found growing scholarly interest in the topic, but also raised questions concerning the quality and reliability of the existing knowledge base. The aim of this study was to investigate how robust the association between school-related stress and internalizing problems is to differences in model specifications.

Methods: Longitudinal survey data from between 2,991 and 4,845 Swedish adolescent students aged 13–16 years were used. A total of 57,322 different models were estimated, varying the choice of sample, measure of internalizing problems, functional form, statistical method, and combinations of included control variables. The results were summarized using specification curve analysis.

Results: Most estimates of the association between school-related stress and internalizing problems were statistically significant at the 5% level. The choice of sample, outcome, functional form, and control variables had a limited influence on the size and significance of the estimates, but the estimates were markedly smaller and mostly non-significant in models investigating lagged effects.

Conclusions: This study showed that school-related stress is a robust predictor of internalizing problems as long as the association is assumed to be contemporaneous, while evidence for lagged effects was weaker. A key conclusion is that the choice of whether to estimate lagged or contemporaneous effects may be the most consequential in studies on school-related stress and internalizing problems or similar topics.

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.

Bakground: Growing educational disparities in mortality due to suicide, drug overdose, or alcohol-related liver disease – or “deaths of despair” (DoD) – have received increased attention in research and public debate. However, no study has investigated educational differences in despair-related mortality outside of North America. Thus, the aim this study was to investigate changes in the association between academic achievement in compulsory school and subsequent all-cause mortality (ACM) and DoD between 1990 and 2018 in Swedish youths.

Data and methods: Register data on all students graduating from compulsory school in Sweden between 1990 and 2010 were used (N = 2 252 938). Students were followed for a maximum of 8 years using discrete time proportional hazard models. Academic achievement was measured by grades at the end of compulsory school.

Results: ACM declined for medium/high achieving but not for low-achieving youths, while DoD increased slightly for medium/high achieving and markedly for low-achieving youths, resulting in growing achievement-related disparities in both types of mortality. The trends were primarily driven by native-born youth and girls.

Conclusions: The trends in Swedish youths resemble the trends in the American working-age population, but partly contrasts with corresponding trends in other European countries. Future research should investigate if the underlying causes that have been emphasized in the American context – socio-economic transformations and a greater supply of drugs – have also contributed to the Swedish trends.

Rising rates of "deaths of despair" – mortality from suicide, drug overdose, and alcohol-related causes – have contributed to widening educational disparities in mortality. It is not known to what extent the trends are due to selection effects (health causing education, or a third factor causing both) or social causation (education affecting health). This study investigated the relative contribution of selection and causation for these trends, focusing on the recently documented widening achievement-based disparities in mortality among Swedish youths.

To this end, two cohorts of Swedish compulsory school graduates (graduating in 1992–1993 and 2009–2010, respectively) were followed for eight years after graduation using comprehensive administrative data (n = 424,715). Logistic regression models were used to assess the role of pre-graduation selection, while inverse odds ratio-weighting was used to assess mediation by post-graduation socioeconomic disadvantages.

Roughly half of the association between low achievement and all-cause and despair-related mortality within cohorts was due to selection. However, selection effects did not explain the widening disparities over time. Socioeconomic mediators accounted for most of the remaining disparities within cohorts as well as of for most of the increase in these disparities over time. Overall, social causation was more important than selection in explaining the widening educational disparities in all-cause and despair-related mortality.

We conclude that low academic achievement increasingly constrains life-course prospects of Swedish youths, amplifying its adverse health consequences. These findings highlight the need for lower barriers in the education system and for viable educational and employment pathways for low-achieving students in an increasingly knowledge-intensive labor market. 

Higher academic performance is almost universally considered a good thing, and most quantitative studies show that performance is positively, although weakly, related to mental health. Simultaneously, however, qualitative studies consistently find that high-performing students and students attending high-performing schools report high levels of stress and other mental health problems. This study investigates a simple explanation for this puzzle – that the relationship between performance and mental health is not linear and is conditional on the performance culture of the school. Data on almost 5000 Swedish students from the Programme for International Student Assessment were used. The results show that the relationship between performance and mental health is generally not linear and that intermediate-performing boys have the best mental health, while both low- and high-performing girls and boys alike have poorer mental health. Although inconclusive, the results also suggest that low-performing students may be vulnerable to a strong school performance culture.