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  • 1.
    Bortes, Cristian
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Growing up with poor health and managing school: Studies on ill health and young people's educational achievements2022Doctoral thesis, comprehensive summary (Other academic)
    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.

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  • 2.
    Bortes, Cristian
    et al.
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Geidne, Susanna
    Eriksson, Charli
    Preventing Alcohol Consumption during Pregnancy: A Randomized Controlled Trial2015In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 7, no 3, p. 289-299Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to report on a brief alcohol intervention for preventing drinking during pregnancy. The Women’s Organizations Committee on Alcohol and Drug Issues (WOCAD) in Swe-den developed an informational brochure about alcohol during pregnancy, intended to reach pregnant women before their first visit at a prenatal clinic. A randomized controlled trial was conducted between 2004 and 2005 to measure whether the brochure had any effect. A total of 564 pregnant women between 17 and 46 years of age are included in the study. Differences between the intervention and control groups were analyzed with cross-tabulations and chi-squared tests. A multiple logistic regression analysis was also conducted to determine predictors of abstention from alcohol at the first prenatal visit. Findings show that significantly more of the women who received the brochure abstained completely from alcohol then of those who did not receive it (92% vs. 82%, p= 0.005). It was 2.6 times more likely that those who received the brochure had abstained completely from alcohol since pregnancy recognition at their first prenatal visit com-pared with those who did not receive it (OR = 2.6, CI 1.3 - 5.1, p = 0.005). We conclude that the in-formational brochure developed by WOCAD can be used in prenatal care to get more women to abstain from alcohol during pregnancy.

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  • 3.
    Bortes, Cristian
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Giota, Joanna
    Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden.
    Beyond academics: Links from teaching practices in Swedish schools to students’ achievements and mental health complaints2024In: Learning and instruction, ISSN 0959-4752, E-ISSN 1873-3263, Vol. 92, article id 101937Article in journal (Refereed)
    Abstract [en]

    Background: Despite extensive research on the relationship between teaching practices and learning outcomes, limited attention has been given to their potential links with students’ mental health.

    Aims: This study investigates the relationships between three teaching practice types – teacher-centered, student-centered, and student-dominated – and both student mental health complaints and academic achievement. It furthers explores variations in these associations based on students’ socioeconomic status (SES).

    Sample: The analysis includes 4573 grade 9 students (aged 15–16 years) in the Swedish comprehensive school system.

    Methods: Employing structural equation modelling techniques, we analyze a dataset comprising students’cognitive test scores, their perceptions of classroom processes, self-reported mental health complaints, as well as register data on teacher-assigned grades and parental education.

    Results: Teacher-centered practices are positively associated with academic achievements but lack robust linkswith mental health complaints. Conversely, student-centered practices are positively associated with academicachievements and correlate with lower mental health complaint frequencies. However, student-dominated practices demonstrate poor relationships with both mental health and academic achievements. Limited variations based on students’ social background reveal only two differing associations between low and high SES students: teacher-centered teaching shows stronger academic achievement associations for low SES students, while student-dominated teaching is more adversely linked to low SES students’ mental health.

    Conclusions: The results affirm the benefits of both teacher- and student-centered teaching practices for academic achievement while cautioning against excessive self-directed teaching. Importantly, the study highlights the role of instructional approaches in shaping not only academic outcomes but also students’ mental health.

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  • 4.
    Bortes, Cristian
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Landstedt, Evelina
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Psychotropic medication use and academic performance in adolescence: A cross-lagged path analysis2021In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 91, p. 25-34Article in journal (Refereed)
    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.

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  • 5.
    Bortes, Cristian
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Associations between children’s diagnosed mental disorders and educational achievements in Sweden2022In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 50, no 8, p. 1140-1147Article in journal (Other academic)
    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.

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  • 6.
    Bortes, Cristian
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ragnarsson, Susanne
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Petersen, Solveig
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    The Bidirectional Relationship Between Subjective Well-Being and Academic Achievement in Adolescence2021In: Journal of Youth and Adolescence, ISSN 0047-2891, E-ISSN 1573-6601, Vol. 50, no 5, p. 992-1002Article in journal (Refereed)
    Abstract [en]

    The well-being of young people in relation to their school performance has received increased attention in recent years. However, there is a lack of knowledge about the longitudinal and reciprocal relationship between adolescents’ subjective well-being and their academic achievements. The current study examined the bidirectional relationship between subjective well-being and academic achievement across two timepoints (T1 and T2) during the course of mid to late adolescence, i.e.,in school year 9 (age 15), and school years 11–12 (ages 17–18). The study also investigated variation in the association as afunction of adolescent gender. Data on subjective well-being and teacher-assigned school grades of 723 adolescents (48.7% girls) residing in Sweden were analyzed by estimating a series of cross-lagged path models. The findings suggest gender differences in the relationship as no associations were found among boys. Support for a bidirectional relationship between the constructs was only found for girls. For girls, higher subjective well-being at T1 was associated with higher academic achievements at T2, while higher academic achievements at T1 was associated with lower subjective well-being at T2. These findings highlight that the subjective well-being of adolescent girls may be important for their ability to perform at school, but their academic achievements may also inflict negatively on their subjective well-being.

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  • 7.
    Bortes, Cristian
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Health problems during childhood and school achievement: Exploring associations between hospitalization exposures, gender, timing, and compulsory school grades2018In: PLOS ONE, E-ISSN 1932-6203, Vol. 13, no 12, p. 1-14, article id e0208116Article in journal (Refereed)
    Abstract [en]

    AIMS:

    To investigate while accounting for health at birth 1) associations between health problems during childhood, measured as hospitalizations, and school achievement in the final year of compulsory school, measured as overall grade points and eligibility for upper secondary education, 2) if and how gender moderates the association between health problems and school achievement, 3) if and how the timing of a health problem during childhood is associated with later school achievement.

    METHODS:

    Analyzes were performed on a population-based cohort (n = 115 196) born in 1990 in Sweden (51.3% boys, 48.7% girls) using data from several national registries. Multiple linear regression and logistic regression were used to analyze associations between study variables.

    RESULTS:

    Overall grade points and eligibility for continuation to upper secondary school were lower for individuals exposed to hospitalizations. Only the association between hospitalizations and overall grade points was moderated by gender and only for ages 13-16 years. Exposure close to actual grading had worst outcomes.

    CONCLUSIONS:

    Health problems, measured through hospitalizations, was significantly associated with lower school achievements among Swedish children. Girls exposed to health problems requiring hospitalizations had relatively poorer school achievements as compared to boys. Health problems requiring hospitalization during junior high school had the greatest negative association with final achievement at compulsory school.

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  • 8.
    Bortes, Cristian
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University, Sweden.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Is the effect of ill health on school achievement among Swedish adolescents gendered?2019In: SSM - Population Health, ISSN 2352-8273, Vol. 8, article id 100408Article in journal (Refereed)
    Abstract [en]

    This study investigates why the relationship between health problems requiring hospitalization between the ages of 13 and 16 and school achievement (school grades in 9th grade) in Sweden was stronger for girls than for boys. We reviewed previous research on gender differences in subjective health, health care utilization and medical drug treatment to identify mechanisms responsible for this gendered effect. The relationship was analysed using retrospective observational data from several national full-population registers of individuals born in 1990 in Sweden (n = 115 196), and ordinary least squares techniques were used to test hypotheses. We found that girls had longer stays when hospitalized, which mediated 15% of the interaction effect. Variability in drug treatment between boys and girls did not explain the gendered effect of hospitalization. The main mediator of the gendered effect was instead differences in diagnoses between boys and girls. Girls’ hospitalizations were more commonly related to mental and behavioural diagnoses, which have particularly detrimental effects on school achievement.

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  • 9.
    Bortes, Cristian
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University, Sweden.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Parental Illness and Young People's Education2020In: Child Indicators Research, ISSN 1874-897X, E-ISSN 1874-8988, Vol. 13, no 6, p. 2069-2091Article in journal (Refereed)
    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.

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  • 10.
    Bortes, Cristian
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Nilsson, Karina
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Sibling Ill-Health and Children's Educational Outcomes2020In: Journal of School Health, ISSN 0022-4391, E-ISSN 1746-1561, Vol. 90, no 5, p. 407-414Article in journal (Refereed)
    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.

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  • 11.
    Landstedt, Evelina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden; Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Bortes, Cristian
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Strandh, Mattias
    Umeå University, Faculty of Social Sciences, Department of Social Work. Centre for Research on Child and Adolescent Mental Health, Karlstad University.
    Is there a social gradient in how youth with mental disorder perform academically? Findings from a Swedish longitudinal register-based study2021In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 21, no 1, article id 441Article in journal (Refereed)
    Abstract [en]

    Background: It is well established that academic achievement and other school-related outcomes are associated with mental health status in children and youths. However, few studies have examined the influence of socioeconomic background on the relationship between poor childhood/adolescent mental health and schoolperformance. From an equity perspective, it is important to explore how school-related outcomes are affected for young people with mental disorder and if these outcomes differ depending on gender and socioeconomic background. This study aimed to investigate social gradients in the prospective association between childhood/adolescent mental disorder and academic achievement.

    Methods: This register based study used data from the Umeå SIMSAM Lab of linked Swedish registers on all children born between 1990 and 1994 and their parents (N = 642 558). The outcome was school grades achieved upon compulsory school graduation (age 15/16). Mental disorder was indicated by number of hospitalisations due to ICD classified mental disorders and prescription of psychoanaleptic drugs. Indicators of socioeconomic position were parental level of education and family income in four categories respectively. Parental history of mental disorder was controlled for. Linear regressions, including interaction analyses, were performed.

    Results: Mental disorder in childhood/adolescence was related to lower grades, particularly in boys. The drop in academic achievement among youth with mental disorder was more pronounced among girls in mid SEP categories than among their less and more advantaged peers. A less clear interaction pattern was identified in boys.

    Conclusions: Based on theory and existing research we expected a typical social gradient in the strength of the association between mental disorder and academic achievement. However, we identified a U-shaped social gradient among girls. Analyses of the links between mental health and academic outcomes need to take both gender andsocial position into account. More research is needed to investigate these patterns further.

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