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Growing up with poor health and managing school: Studies on ill health and young people's educational achievements
Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.ORCID-id: 0000-0001-6008-2296
2022 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Aim and objectives: The overall aim of this thesis was to empirically investigate consequences of poor health for children’s educational outcomes in Sweden. A central tenet is that health problems impact not only the afflicted individual but also people in their social and emotional proximity, in particular immediate family members. More specific objectives were to study: 1. The relationship between multiple clinically diagnosed mental disorders and children’s educational achievements in Sweden. 2. The bidirectional relationship between mental health problems and academic performance among Swedish adolescents, as well as heterogeneous patterns associated with gender and socioeconomic groups. 3. The effects of parental somatic and psychiatric health problems on the probability of youths leaving upper secondary education before completion in Sweden and potential gender differences in these effects. 4. The relationship between having a sibling with health problems and a healthy sibling’s school grades in the final year of compulsory education in Sweden and how socioeconomic background modifies this relationship.

Theoretical framework: Key concepts applied in the thesis are health and illness. The ability to perform things in life, the ability to act, determines whether a person is healthy or ill. Illness (or poor health, treated as a synonymous term) entails a reduced ability to act in relation to one’s life situation and its demands. Family is viewed from a systems theory perspective. Poor health of a parent reduces his or her ability to maintain regular roles, which may require reorganisation of the family system. Siblings’ health problems can affect other children in the family by inducing concerns and occupying and diverting parents’ time and attention. All of this could be psychosocially stressful in many ways, not least for children in the family and their ability in relation to schooling.

Data and methods: The research objectives were addressed by utilising social and medical microdata from Swedish administrative registers covering the entire population in Sweden. Data pertaining to different populations, collectively covering the period from 1987 to 2017, were used in four studies designated Studies I–IV. Educational achievement was measured in terms of teacher-assigned school grades awarded by the end of compulsory school and in upper secondary school, as well as completion (or non-completion) of an upper secondary education. Poor health was measured through data on outpatient visits to specialist healthcare facilities, psychotropic drug prescriptions and admissions/discharges from Swedish hospitals. Socioeconomic background was measured by parental level of education. The data were analysed by fitting linear and logistic regression models as well as cross-lagged path models.

Results and conclusions: Empirical results of Study I showed that specific diagnosed mental disorders have varying, largely disadvantageous, associations with educational achievements of students that differ between boys and girls. Documentation of this in Sweden adds to evidence that mental disorders have a negative overall association with educational achievement, despite substantial variation in support and educational systems across countries. The results of Study II provided no support for a bidirectional relationship between mental health and academic performance of students aged 15-16 to 18-19 years. However, they support a unidirectional relationship, as a negative relationship was found between school grades at graduation from compulsory school and rates of subsequent psychotropic medication use in upper secondary school. The relationship was equal in size for both boys and girls but mainly among adolescents with the highest educated parents.

Study III showed that having a mother or a father with psychiatric, but not somatic, illness that necessitated hospitalisation after completing compulsory schooling was associated with an increased probability of leaving upper secondary school before completion. No significant gender-based differences in this were found. Results presented in Study IV showed that having one or more siblings with health problems that necessitated recurrent hospitalisations was associated with lower grades. Children with ill siblings were also less likely to be eligible for an upper secondary education compared to children whose siblings did not have poor health. Socioeconomic background did not affect this educational disadvantage.

Results presented in this thesis clearly corroborate the importance of health for children’s education. Children’s educational achievements at the end of compulsory school are inversely related to mental health problems in their adolescence. Thus, academic competence may have positive effects on certain aspects of young people’s mental health, which underscores the importance of promoting opportunities for youth to do as well as they can in school. The reciprocal aspect of the relationship between mental health and academic performance among school-aged children remains an important issue that requires further investigation. However, health is not just an individual issue; parents’ and siblings’ health problems can affect children and have negative ‘spillover’ effects on their schooling and educational achievements. This underlines the importance of a psychosocial perspective when identifying children’s difficulties in school. Taken together, health, and thus the school’s student health task, is highly associated with academic achievement and schools’ pedagogical responsibilities.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå Universitet , 2022. , s. 66
Serie
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 99
Nyckelord [en]
Educational acchievements, Health, Bidirectionality, Family, Parents, Siblings, Register data
Nationell ämneskategori
Socialt arbete
Forskningsämne
sociologi; psykiatri; folkhälsa
Identifikatorer
URN: urn:nbn:se:umu:diva-192131ISBN: 978-91-7855-732-5 (tryckt)OAI: oai:DiVA.org:umu-192131DiVA, id: diva2:1634373
Disputation
2022-03-04, UB.A.210, Lindellhallen 1, Umeå, 10:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2022-02-11 Skapad: 2022-02-02 Senast uppdaterad: 2024-07-02Bibliografiskt granskad
Delarbeten
1. Associations between children’s diagnosed mental disorders and educational achievements in Sweden
Öppna denna publikation i ny flik eller fönster >>Associations between children’s diagnosed mental disorders and educational achievements in Sweden
2022 (Engelska)Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, nr 8, s. 1140-1147Artikel i tidskrift (Övrigt vetenskapligt) Published
Abstract [en]

Aims: To examine associations between multiple clinically diagnosed mental disorders among children in Sweden and educational achievements at the end of ninth grade.

Methods: Data from Swedish administrative registers were utilised. Diagnoses of specific mental disorders (unipolar depression, mood, anxiety, obsessive compulsive, eating, attention deficit hyperactivity disorder) were used as exposure variables. Educational achievements were assessed in terms of teacher-assigned school grades and eligibility for upper secondary education. The sample comprised 266,664 individuals (49% females) born in 2000 to 2002 who were alive and resident in Sweden in 2017. Exposed and unexposed individuals were compared in terms of outcome variables by fitting linear and logistic regression models.

Results: The results revealed negative associations between all the examined mental disorders and educational achievements, except for positive associations between eating disorders and grades among female students. Attention deficit hyperactivity disorder was the most strongly associated disorder in terms of non-successful completion of compulsory education, among both male and female students (odds ratio (OR): 3.58 (95% confidence interval (CI), 3.42 to 3.74) and 4.31 (95% CI, 4.07 to 4.57), respectively). This was followed by unipolar depression among males (OR: 2.92 (95% CI, 2.60 to 3.28)) and anxiety disorder among females (OR: 2.68 (95% CI, 2.49 to 2.88)). Obsessive compulsive disorder had the weakest negative association with educational achievements among both males (OR: 1.48 (95% CI, 1.01 to 2.17)) and females (OR: 1.38 (95% CI, 1.11 to 1.72)).

Conclusions: Specific diagnosed mental disorders have varying, largely disadvantageous, associations with educational achievements of students in Sweden that differ between males and females.

Ort, förlag, år, upplaga, sidor
Sage Publications, 2022
Nyckelord
Mental disorders, educational achievement, register data, Sweden, sex differences
Nationell ämneskategori
Socialt arbete
Identifikatorer
urn:nbn:se:umu:diva-192125 (URN)10.1177/14034948221089056 (DOI)000783876500001 ()35416111 (PubMedID)2-s2.0-85129236583 (Scopus ID)
Forskningsfinansiär
VetenskapsrådetRiksbankens Jubileumsfond
Anmärkning

Originally included in thesis in manuscript form. 

Tillgänglig från: 2022-02-02 Skapad: 2022-02-02 Senast uppdaterad: 2023-03-23Bibliografiskt granskad
2. Psychotropic medication use and academic performance in adolescence: A cross-lagged path analysis
Öppna denna publikation i ny flik eller fönster >>Psychotropic medication use and academic performance in adolescence: A cross-lagged path analysis
2021 (Engelska)Ingår i: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 91, s. 25-34Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Introduction: The study investigated the directionality of associations between mental health problems and school grades across two timepoints (T1 and T2) during mid to late adolescence; inschool year 9 (ages 15–16) and school year 12 (ages 17–18). The study also investigated variation in the associations as a function of gender and across socioeconomic groups.

Methods: Longitudinal data from several Swedish administrative registers were utilised. Information on prescribed psychotropic drugs was used as a proxy for mental health problems, and teacher-assigned school grades were used to measure academic performance. The study sample comprised 85 186 individuals (50.7% girls) born in 1991 who were alive and resident in Sweden in 2010. Directions of associations were analysed by estimating a series of cross-lagged path models.

Results: The model with the best fit to data showed that higher school grades at T1 were associated with relatively lower rates of mental health problems by T2, for both boys and girls, mainlyi n socioeconomic groups with the highest educated parents. This association was equal in size across all of the socioeconomic groups that were explored.

Conclusions: Performing well in school is equally important for boys’ and girls’ subsequent mental health, but only among adolescents in socioeconomic groups with the highest educated parents. The results underscore the importance of promoting opportunities for youth to do as well as theycan in school.

Ort, förlag, år, upplaga, sidor
Elsevier, 2021
Nyckelord
Mental health, Academic performance, Cross-lagged panel analysis, Bidirectional associations, Gender differences, Socioeconomic background
Nationell ämneskategori
Socialt arbete
Identifikatorer
urn:nbn:se:umu:diva-186299 (URN)10.1016/j.adolescence.2021.07.003 (DOI)000685543000003 ()34298339 (PubMedID)2-s2.0-85110755387 (Scopus ID)
Forskningsfinansiär
Vetenskapsrådet, 2014-1992Marianne och Marcus Wallenbergs Stiftelse, 2014.0154
Tillgänglig från: 2021-07-21 Skapad: 2021-07-21 Senast uppdaterad: 2023-09-05Bibliografiskt granskad
3. Parental Illness and Young People's Education
Öppna denna publikation i ny flik eller fönster >>Parental Illness and Young People's Education
2020 (Engelska)Ingår i: Child Indicators Research, ISSN 1874-897X, E-ISSN 1874-8988, Vol. 13, nr 6, s. 2069-2091Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The purpose of the present study was to investigate the effects of parental health problems on the probability of youths leaving upper secondary education before completion in Sweden, and to investigate potential gender differences in these effects. Medical and social microdata from Swedish administrative registers were used. The study population consisted of individuals born between 1987 and 1990 (N = 398,748) who were still alive and residing in Sweden in 2010. We employed a quasi-experimental pre-test post-test study design. Logistic regression was used to analyse the relationships between indicators of parental illness and young people's early school leaving in relation to health and sociodemographic confounders. Having had a mother or father with psychiatric, but not somatic, illness that necessitated hospitalisation after completing compulsory schooling was significantly associated with an increased probability of leaving upper secondary education. We found no significant gender-specific interaction effects. The existence of these effects in Sweden, a country with an extensive institutional welfare system, suggests that similar but more pronounced effects may exist in regions lacking such systems.

Ort, förlag, år, upplaga, sidor
Springer, 2020
Nyckelord
Parental health, Academic achievement, Early school leaving, Registry data, Sweden
Nationell ämneskategori
Socialt arbete
Identifikatorer
urn:nbn:se:umu:diva-169551 (URN)10.1007/s12187-020-09731-x (DOI)000524209800001 ()2-s2.0-85084658947 (Scopus ID)
Forskningsfinansiär
Vetenskapsrådet, 2014-1992Marianne och Marcus Wallenbergs Stiftelse, 2014.0154
Tillgänglig från: 2020-04-06 Skapad: 2020-04-06 Senast uppdaterad: 2022-02-02Bibliografiskt granskad
4. Sibling Ill-Health and Children's Educational Outcomes
Öppna denna publikation i ny flik eller fönster >>Sibling Ill-Health and Children's Educational Outcomes
2020 (Engelska)Ingår i: Journal of School Health, ISSN 0022-4391, E-ISSN 1746-1561, Vol. 90, nr 5, s. 407-414Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: The presence of health problems in a child is known to be negatively associated with later academic achievement, but less is known about the educational outcomes for siblings of children in poor health. The study investigated how having a sibling with health problems affects a healthy sibling’s academic achievement.

METHODS: We utilized medical and social microdata from Swedish administrative population registers. Our sample consisted of N = 115 106 individuals (51.3% boys) born in 1990 in Sweden. We compared children with ill siblings to children whose siblings did not have poor health. Siblings’ hospital admissions and the academic achievements of the healthy sibling during their final year of compulsory education (at the age of 15-16) were analyzed using linear and logistic regression in relation to individual health- and family-related confounders.

RESULTS: Sibling hospitalization was significantly associated with lower overall grade points (b = –10.73, p < .001) and an increased odds ratio (OR) of ineligibility for upper secondary education (OR = 1.42, 95% CI = 1.31-1.52, p < .001).

CONCLUSIONS: School and health personnel should also consider the needs of healthy siblings during their work with children in poor health, because they too can be disadvantaged.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2020
Nationell ämneskategori
Socialt arbete
Identifikatorer
urn:nbn:se:umu:diva-166715 (URN)10.1111/josh.12887 (DOI)000516651300001 ()32105351 (PubMedID)2-s2.0-85080107441 (Scopus ID)
Forskningsfinansiär
Vetenskapsrådet, Dnr.2014-1992Marianne och Marcus Wallenbergs Stiftelse, 2014.0154
Tillgänglig från: 2019-12-20 Skapad: 2019-12-20 Senast uppdaterad: 2023-03-24Bibliografiskt granskad

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