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Aims: There is a strong achievement-gradient in attention-deficit hyperactivity disorder (ADHD), with a higher prevalence in children with low academic achievement. In Sweden, the prevalence of ADHD is also higher among native than immigrant children. The aim of this study was to investigate whether the change in diagnosed ADHD varies across different achievement levels, and whether this change in turn differs depending on students’ immigration status.

Methods: Register data on all students graduating from compulsory school in Sweden between 2001 and 2018 were used. ADHD was measured by diagnosis in specialised care recorded in the year of graduation, and academic achievement by students’ grade point average. Logistic regression models with ADHD as the outcome were used. Changes in the association between achievement and ADHD over time were tested by including interactions terms for achievement and year.

Results: There was a positive interaction between achievement and year in the pooled sample, meaning that ADHD increased relatively more among higher-achieving students and that the achievement-gradient in ADHD diminished over time. In stratified analyses, the greatest relative increase in ADHD was observed among higher-achieving native and second-generation immigrant students, and the smallest among low-achieving first-generation immigrants. The achievement-gradient was flatter, and diminished more, among immigrant students.

Conclusions: The reduced achievement-gradient in ADHD suggests that the absence of academic difficulties to a lesser degree disqualifies children from diagnosis. The limited increase among low-achieving first-generation immigrants may indicate persistent barriers to diagnosis and care in this group.

Sexual initiation and refusal are key contributors to sexual health, but despite their importance there has been limited research on how sexual initiation and refusal are learned. Therefore, we explored associations between sexual initiation and refusal, and satisfaction with the reception of information from school-based cross-curricular sexuality education. For this we used empirical data from SRHR 2017 [Sexual and Reproductive Health and Rights 2017], a nationally representative dataset in Sweden. The findings revealed a positive relationship between satisfaction with school-based cross-curricular sexuality education and sexual refusal and initiation for men, but not women. The strongest association between satisfaction with school-based cross-curricular sexuality education and perceived sexual initiation and refusal was found among men who were satisfied with their education. The main strengths of our analysis are the unusually high statistical power of the analyses, the use of randomised data, and inclusion of sub-groups that have rarely been included in earlier research.

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.

Background: Individual histories of abuse characteristics and other adversities must be considered to understand poly-victimization and its impact on ill-health, which suggests the importance of understanding how experiences of violence are interconnected over a life-course.

Objective: To explore gendered patterns of lifetime poly-victimization—physical, emotional, and sexual—and examine how distinct exposure profiles relate to adult health outcomes. The analysis is guided by the Trauma-Informed Theory of Individual Health Behavior (TTB) framework to deepen understanding of gendered trauma trajectories and their long-term effects.

Methods: 10 337 Swedish women and men aged 18–74 participated in a combined online and postal survey. Attrition bias was controlled for based on official registry information. Latent Class Analysis (LCA) was used for identification of groups. Associations between mental and physical health indicators and health-related risk behaviors were analyzed using logistic regression, adjusting for background variables including age, self-reported parental immigrant status, and parental educational attainment.

Results: Patterns of lifetime poly-victimization were more complex among women (7 classes) than men (4 classes). Among men, exposure was primarily characterized by childhood physical and emotional violence, as well as adult non-partner physical violence. In contrast, women's profiles often included childhood sexual violence and partner violence in adulthood, with stronger associations to multiple health problems and risk behaviors, and generally higher odds ratios compared to men. Among women, three unique clusters were identified, one of which may reflect more advanced resilience capacities compared to other clusters with similar trajectories of childhood violence exposure.

Conclusions: Gendered patterns of poly-victimization and their health-related consequences underscore the importance of early intervention to prevent revictimization. The identification of unique and resilient clusters among women, despite similar childhood violence exposure, highlights the need for further research into protective mechanisms and trauma-to-benefit pathways, as conceptualized within the TTB framework.

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.

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.

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.

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.