Loneliness, belonging and psychosomatic complaints across late adolescence and young adulthood: a Swedish cohort study.

BACKGROUND: Loneliness and belonging refer to social connectedness and are associated with young people's health; however, the relationship between these constructs and their impact on health is still being discussed. A dual continuum model of belonging and loneliness has been suggested, consisting of four groups depending on the state of loneliness and belonging: socially fulfilled (low loneliness, high belonging), socially indifferent (low loneliness, low belonging), socially searching (high loneliness, high belonging), and socially distressed (high loneliness, low belonging). The aim of this study is to examine loneliness and belonging in a Swedish sample of 17-18-years-olds who were followed over 3 years, and the associations that these aspects share with young people's psychosomatic complaints during these ages. METHODS: Swedish cohort data collected among late adolescents (age 17-18 in 2019) who were followed up in young adulthood (age 20-21 in 2022) (n = 2684) was used to examine the associations between loneliness, belonging, and psychosomatic complaints. Loneliness and belonging were measured by single items and the cross-combinations of these. Three psychosomatic complaints were assessed: stomach ache, headache, and difficulties falling asleep, and a summary index was calculated. RESULTS: Linear regression analyses showed that loneliness was positively and belonging was negatively cross-sectionally associated with psychosomatic complaints. The socially fulfilled group reported fewer psychosomatic complaints compared to all other groups, while the socially distressed group reported the highest level of psychosomatic complaints. Additional adjustment for sociodemographic characteristics barely affected the estimates. The prospective analysis supported these patterns; however, after adjustment for earlier psychosomatic complaints, the only statistically significant difference in subsequent psychosomatic complaints was found between the socially fulfilled and the socially distressed groups. CONCLUSIONS: Loneliness and belonging (separately and the cross-combinations of these) were cross-sectionally associated with psychosomatic complaints in late adolescence and in young adulthood. Prospectively, only the most vulnerable group in the dual continuum model, the socially distressed group, experienced more psychosomatic complaints than the socially fulfilled group, indicating a temporal relationship. Knowledge about the more nuanced links may be useful for developing specific public health recommendations and interventions for youth, targeting the most vulnerable groups.

Trust in adolescence and depression and anxiety symptoms in young adulthood: findings from a Swedish cohort.

OBJECTIVE: Trust and health are both fundamental elements of a socially sustainable society. While much research has shown that trust is associated with better mental health outcomes in adults, studies of young people are relatively scarce, despite the fact that mental health problems are common in young ages. In particular, there are few longitudinal studies that cover different dimensions of trust. Building on a previous study on trust and psychosomatic complaints in adolescents, the aim was to examine the links between generalised and institutional trust in adolescence and depression and anxiety symptoms in young adulthood. Data was obtained from a Swedish cohort study with self-reported information on generalised and institutional trust at ages 15-16 and 17-18 and depression and anxiety symptoms at age 20-21 (n = 2,668). Covariates included sociodemographic characteristics and indicators of prior mental health status. RESULTS: Binary logistic and linear regressions showed that higher levels of generalised trust at ages 15-16 and 17-18 were inversely associated with depression and anxiety symptoms at age 20-21. Institutional trust was however not linked with subsequent depression and anxiety symptoms when adjusting for generalised trust and covariates. The findings indicate that generalised trust is a social determinant for mental health in young people.

Bullying experiences before and after the transition from lower to upper secondary school: associations with subsequent mental health in a Swedish cohort.

BACKGROUND: Previous research has shown that exposure to bullying is linked to long-term adverse mental health consequences. However, prospective studies examining the persistence of bullying, using information from repeated time points, are limited. The aim of this study was to examine, firstly, the extent to which exposure to bullying among adolescents in Sweden changes between grades 9 (age 15-16) and 11 (age 17-18) (i.e., before and after the transition from lower to upper secondary school); secondly, whether being bullied in grade 9 or 11 is associated with depression and anxiety symptoms at age 20-21; and thirdly, if being bullied in both grade 9 and 11 is linked to an even higher likelihood of subsequent depression and anxiety symptoms. Potential differences by gender were investigated throughout. METHODS: Data was derived from the Swedish cohort study Futura01 involving individuals attending grade 9 in the school year 2016/17 (n = 2323). We utilised self-reported information from three survey waves conducted in 2017, 2019, and 2022, and linked registry information on sociodemographic characteristics. Bullying was assessed using a single item in waves 1 and 2. Depression and anxiety symptoms were measured using the Patient Health Questionnaire-4 (PHQ-4) in wave 3. Gender stratified binary logistic regressions were performed. RESULTS: Among those who were bullied in grade 9, 22.6% of males and 35.8% of females continued to experience bullying in grade 11. For females, exposure to bullying in grade 9 or 11 was associated with an increased likelihood of reporting depression and anxiety symptoms at age 20-21, with the highest odds for those bullied at both time points. For males, only one statistically significant association was identified - specifically, between being bullied in grade 9 and subsequent depression symptoms. CONCLUSIONS: For a majority of adolescents who experience bullying in lower secondary school, but not all, the transition to upper secondary school proves to be beneficial as the bullying typically does not persist. However, bullying can have long-term health effects, in particular for females. These findings emphasise the importance of effective measures to address bullying within schools.

Trust and Psychosomatic Complaints in Adolescence: Findings From a Swedish Cohort Study.

Objectives: To examine the cross-sectional and longitudinal associations between generalised and institutional trust and psychosomatic complaints in mid and late adolescence. Methods: Data were derived from the Swedish cohort study Futura01, using survey information collected amongst 3,691 grade 9 students (∼15-16 years, t1) who were followed-up 2 years later (∼17-18 years, t2). Registry information on sociodemographic characteristics was linked to the data. Linear regression analyses were performed. The longitudinal analyses applied the first difference (FD) approach as well as the lagged dependent variable (LDV) approach. Covariates included gender, family type, parental education, parental country of birth, and upper secondary programme. Results: Higher levels of generalised and institutional trust were cross-sectionally associated with lower levels of psychosomatic complaints at both time points. The FD analyses showed that increases in generalised and in institutional trust between ages 15-16 and 17-18 years were associated with corresponding decreases in psychosomatic complaints. The LDV analyses demonstrated reciprocal temporal associations between trust and psychosomatic complaints. Conclusion: The findings indicate that trust is a social determinant of psychosomatic complaints in adolescents, but also that health may affect trust.

Prospective associations between psychosomatic complaints in adolescence and depression and anxiety symptoms in young adulthood: A Swedish national cohort study.

Background: Psychosomatic complaints are reported by high shares of adolescents in Sweden and elsewhere. Yet, little is known about to the extent to which the frequency, number, and persistence of such complaints in adolescence are associated with subsequent mental health problems. The aim of this study was to examine how the frequency, number, and persistence of psychosomatic complaints in middle and late adolescence are associated with depression and anxiety symptoms in young adulthood. Methods: A Swedish national cohort study of adolescents who were surveyed in 2017 (t1; age 15-16), in 2019 (t2; age 17-18) and in 2022 (t3; age 20-21 years) was used. Psychosomatic complaints were measured by questions on stomach ache, headache and difficulties falling asleep at t1 and t2. Depression and anxiety symptoms were measured by the Patient Health Questionnaire-4 (PHQ-4) at t3. Multivariable binary logistic regression analyses stratified by gender were based on data from t1, t2 and t3 (n = 2779). Results: The frequency, number, and persistence of psychosomatic complaints during adolescence were associated with symptoms of depression and anxiety in young adulthood. Both earlier (at t1 only) and more recent (at t2 only) complaints were linked to subsequent depression and anxiety symptoms, while persistent (at both t1 and t2) psychosomatic complaints showed stronger associations in girls. Conclusions: Psychosomatic complaints in adolescence were associated with depression and anxiety symptoms in young adulthood. This was true for the frequency, number, and persistence of psychosomatic complaints. Among girls, those who reported persistent psychosomatic complaints from middle to late adolescence had the highest likelihood of reporting subsequent depression and anxiety symptoms. Taken together, the results indicate that psychosomatic complaints during adolescence can translate into later depression and anxiety symptoms. Furthermore, repeated measurements of psychosomatic complaints can be used to identify the most vulnerable group.

Is there a peer status gradient in mortality? Findings from a Swedish cohort born in 1953 and followed to age 67.

BACKGROUND: Similar to having a less advantaged socioeconomic position, children in lower peer status positions typically experience a situation characterized by less power, influence and command over resources, followed by worse health outcomes. The aim of this study was to examine whether peer status position is further associated with increased risks for premature all-cause mortality. METHODS: Data were drawn from a 1953 cohort born in Stockholm, Sweden. Peer status positions were established through survey data on peer nominations within the school class at age 13, whereas national registers were used to identify all-cause mortality across ages 14-67. Differences in hazard rates and median survival time, according to peer status position, were estimated with Cox regression and Laplace regression, respectively. RESULTS: Although differences in hazard rates were not large, they were consistent and clear, also after taking childhood socioeconomic status into account. Regarding median survival time, the number of years lost increased gradually as peer status decreased, with a difference of almost 6 years when comparing individuals in the lowest and highest positions. CONCLUSIONS: Children's positions in the peer status hierarchy play a role for their chances of health and survival, pointing to the relevance of addressing opportunities for positive peer interaction and mitigating any adverse consequences that may stem from negative experiences within the peer context.

Workplace bullying, symptoms of anxiety and the interaction with leadership quality - a longitudinal study using dynamic panel models with fixed effects.

OBJECTIVES: Workplace bullying has been suggested to increase symptoms of anxiety. A reverse relationship has also been proposed. However, so far only few earlier studies have investigated this topic and the reported associations might partly be explained by unmeasured individual characteristics. In this study, we aim to examine the temporality and directionality between workplace bullying and anxiety symptoms, taking time-invariant characteristics into account. Furthermore, we aim to examine whether leadership quality modifies these associations. METHODS: We included 13 491 individuals from two nationwide cohort studies in Sweden and Denmark. Using cross-lagged structural equation models (SEM) and dynamic panel models with fixed effects, we examined contemporaneous and lagged associations between self-reported workplace bullying and anxiety. Cohort-specific results were estimated and combined using fixed-effect meta-analysis. RESULTS: The cross-lagged SEM models supported contemporaneous and lagged relationships in both directions (from workplace bullying to symptoms of anxiety and vice versa). In contrast, only contemporaneous relationships remained statistically significant and of considerable magnitude in the dynamic panel models with fixed effects. Specifically, exposure to workplace bullying was related to a concurrent increase in anxiety symptoms (b=0.61, 95% confidence interval 0.32-0.90). No support of interaction with leadership quality was found. CONCLUSIONS: The results indicate that onset of workplace bullying is associated with an immediate or short-term increase in anxiety symptoms. This study provides novel insights regarding temporal aspects and causal inference of the bullying-anxiety relationship useful for managing psychological hazards and preventing mental illness at work.

Parenting Practices and Psychosomatic Complaints Among Swedish Adolescents.

Objectives: Parent-adolescent relationships play a crucial role in youth development. This study examines the associations between parenting practices (parental support, knowledge, and rule-setting) and psychosomatic complaints across middle and late adolescence. Methods: The study utilised data from a Swedish national cohort (n = 3,678). Participants completed self-report questionnaires in 2017 (∼15-16 years) and again in 2019 (∼17-18 years). Results: Parental support exhibited the strongest and most consistent inverse cross-sectional associations with psychosomatic complaints during both middle and late adolescence. Furthermore, increases in parental support and parental knowledge were associated with decreases in adolescent psychosomatic complaints. However, parental support and knowledge at age 15-16 were not prospectively associated with psychosomatic complaints at age 17-18. Conclusion: These findings underscore the importance of ongoing parental engagement, particularly in terms of providing constant support, throughout middle and late adolescence.

Psychosocial School Conditions and Mental Wellbeing Among Mid-adolescents: Findings From the 2017/18 Swedish HBSC Study.

Objectives: To investigate mid-adolescent boys' and girls' experiences of school demands, teacher support, and classmate support, and explore the associations of these factors with mental wellbeing. Methods: Data were derived from the Swedish Health Behaviour in School-aged Children (HBSC) study of 2017/18, with information collected among 1,418 students in grade 9 (∼15-16 years). School demands, teacher support, and classmate support were measured by indices based on three items each. Mental wellbeing was measured by the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Linear regression analyses were performed. Results: Higher demands were associated with lower mental wellbeing. Conversely, mental wellbeing increased with greater teacher support and classmate support. Interactions between demands and the support variables showed that at the lowest levels of teacher and of classmate support, mental wellbeing was low and not associated with school demands. With increasing levels of teacher and classmate support, the overall level of mental wellbeing increased and revealed an inverse association between school demands and mental wellbeing. Conclusion: The study contributes with knowledge about how psychosocial conditions in school may hinder or enhance wellbeing among students.

How do educational disparities in smoking develop during early life? A Swedish longitudinal study.

Smoking contributes to health inequalities, but how social inequalities in smoking develop in early life remains unclear. This study examines how measures of education attained over the early life course (representing socioeconomic position of origin, socioeconomic position of destination, and in-between) contribute to smoking behavior in a Swedish longitudinal sample. We used data obtained from the Swedish Level-of-Living Surveys in addition to national register data. Young adults (aged 20-28, n = 749) self-reported their educational attainment and smoking behavior (initiation and cessation) in 2010. Ten years earlier, their parents self-reported their own education and smoking behavior. We used linked register data on school performance in adolescence (in grade 9). Logistic regression models showed that lower parental education, lower adolescent school performance, and low young adult educational attainment were respectively associated with young adult smoking initiation. The association between parental education and young adult smoking initiation was explained by adolescent school performance and not parental smoking. Young adult smoking cessation was associated with high parental education and high adolescent school performance (marks in the top quartile), but only school performance remained significant in the final model, which included all measures of education and parental smoking. Results suggest that school performance in adolescence (which connects adolescents' socioeconomic position of origin with their destination) may play an important role in how educational disparities in smoking form over the life course.

Childhood vaccination coverage in Australia: an equity perspective.

BACKGROUND: This study describes trends in social inequities in first dose measles-mumps-rubella (MMR1) vaccination coverage in Western Australia (WA) and New South Wales (NSW). Using probabilistically-linked administrative data for 1.2 million children born between 2002 and 2011, we compared levels and trends in MMR1 vaccination coverage measured at age 24 months by maternal country of birth, Aboriginal status, maternal age at delivery, socio-economic status, and remoteness in two states. RESULTS: Vaccination coverage was 3-4% points lower among children of mothers who gave birth before the age of 20 years, mothers born overseas, mothers with an Aboriginal background, and parents with a low socio-economic status compared to children that did not belong to these social groups. In both states, between 2007 and 2011 there was a decline of 2.1% points in MMR1 vaccination coverage for children whose mothers were born overseas. In 2011, WA had lower coverage among the Aboriginal population (89.5%) and children of young mothers (89.3%) compared to NSW (92.2 and 92.1% respectively). CONCLUSION: Despite overall high coverage of MMR1 vaccination, coverage inequalities increased especially for children of mothers born overseas. Strategic immunisation plans and policy interventions are important for equitable vaccination levels. Future policy should target children of mothers born overseas and Aboriginal children.

Social inequities in vaccination coverage among infants and pre-school children in Europe and Australia - a systematic review.

BACKGROUND: Herd immunity levels of vaccine uptake are still not reached in some high-income countries, usually in countries with persisting social inequities in uptake. Previous studies have focused on factors within one health care system. This study takes a broader health care systems approach by reviewing the socioeconomic distribution of vaccination coverage on the national level in light of structural and organizational differences of primary care for children. METHODS: A systematic literature review of socio-economic patterns of uptake of Measles-Mumps-Rubella (MMR) and/or Diphteria-Tetanus-Pertusis (DTP) in population based studies of children 0-5 years of age living in the 30 European Economic Area (EEA) or European Free Trade Association (EFTA) countries and Australia, was carried out using the PRISMA guidelines. The health care system in the countries in the study were categorized by degree of freedom of the primary care provider (hierarchical or non-hierarchical) and whether preventive services were provided in a separate organization (well-baby clinics). RESULTS: The review identified 15 studies from 10 European countries and Australia that fulfilled the criteria. Although the heterogeneity of the socio-economic indicators did not allow for a conclusive meta-analysis, the study pointed towards lower levels of inequities in primary care models with well-baby clinics. In non-hierarchical primary care organizations that also lacked well-baby clinics, socioeconomic gaps in uptake were often found to be large. CONCLUSION: This review indicates that structural and organizational aspects of health care systems for young children are important for equity in vaccine uptake.

School Demands and Coping Resources-Associations with Multiple Measures of Stress in Mid-Adolescent Girls and Boys.

Stress, and stress-related health complaints, are common among young people, especially girls. Since studies have shown that school demands are an important driver of stress in adolescents, identifying if school-based resources can protect against stress is highly relevant. The aim of this study was to analyse task-related demands and task-related coping resources as aspects of the school work environment of potential relevance for stress in mid-adolescent girls and boys. The data came from "The School Stress and Support study" (TriSSS) conducted among students in grades 8 and 9 (aged 14⁻16 years). Self-reports of demands, coping resources, stress, as well as recurrent pain, were collected through questionnaires (n = 411). A subsample of students (n = 191⁻198) also provided salivary samples, which were analysed for the stress marker cortisol. Linear (OLS) and binary logistic regression analyses showed that higher demands were associated with more perceived stress, a higher likelihood of recurrent pain, and a lower cortisol awakening response. Greater coping resources were associated with less perceived stress and a lower likelihood of recurrent pain, but there was no association with cortisol. The strength of the associations differed by gender. The findings suggest that schools can promote student wellbeing by providing clear and timely information and teacher support to the students, especially for boys. Identifying specific features of the schoolwork that give rise to stress and to modify these accordingly is also of importance, especially for girls.

Parental education differentially predicts young adults' frequency and quantity of alcohol use in a longitudinal Swedish sample.

BACKGROUND: Alcohol consumption contributes to health inequalities, but few studies have examined how socially differentiated alcohol use develops across the life course. In this study, we examine how one aspect of childhood socioeconomic position (parental education) relates to two often-conflated young adult drinking patterns: drinking frequency and quantity per occasion. Using a life course perspective, we also explore whether parental drinking patterns or young adults' own educational attainment might account for such associations. METHODS: This study used longitudinal data from the nationally representative Swedish Level of Living Surveys (LNU). Young adults' (aged 20-28, n = 803) drinking patterns and educational attainment were determined through the LNU 2010 and official registers. A decade earlier, parents self-reported their education and drinking patterns in the LNU 2000 and Partner-LNU 2000. RESULTS: Logistic regression models showed that high parental education predicted young adult frequent drinking, while low parental education predicted young adult high quantity drinking. Drinking patterns were associated inter-generationally, but parental alcohol use did not account for differences in young adult drinking patterns by parental education. Young adults' own education similarly predicted their drinking patterns but did not account for differences in drinking frequency by parental education. Differences in drinking quantity by parental education were no longer significant when young adults' own education was included in the final model. CONCLUSIONS: Findings suggest that parental education constitutes an early-life structural position that confers differential risk for young adult drinking patterns. Young adults whose parents had low education were less likely to drink frequently but were more likely to drink heavily per occasion, a drinking pattern that may place more disadvantaged young adults at a greater health risk.

Out-of-Home Care and Subsequent Preterm Delivery: An Intergenerational Cohort Study.

OBJECTIVES: Adverse early-life experience may affect preterm delivery later in life through priming of stress response. We aim to investigate the links between out-of-home care (OHC) experience in childhood, as a proxy of severe adversities, on subsequent risk of preterm delivery. METHODS: A register-based national cohort of all women born in Sweden between 1973 and 1977 (N = 175 821) was crosslinked with information on these women's subsequent deliveries as recorded in the Swedish medical birth register. During 1986-2012, 343 828 livebirths of these women were identified. The associations between women's OHC experience and her risk of preterm delivery were analyzed through logistic regression models, adjusting for women's own preterm birth, intrauterine growth, and childhood socioeconomic situation. RESULTS: Compared with women that never entered OHC, women with OHC experience up to and after age 10 were both associated with increased risks of preterm delivery (adjusted odds ratio [aOR] = 1.23 [95% confidence interval 1.08-1.40] and aOR = 1.29 [1.13-1.48], respectively). Women who experienced OHC before or at 10 years of age had increased risk of both spontaneous and medically indicated preterm delivery (aOR = 1.19 [1.03-1.38] and aOR = 1.27 [1.02-1.59], respectively). Women who experienced OHC after age 10 had a more pronounced risk of medically indicated preterm delivery (aOR = 1.76 [1.44-2.16]) than for spontaneous preterm delivery (aOR = 1.08 [0.92-1.27]). CONCLUSIONS: Women who were placed in OHC in childhood had increased risk of preterm delivery independent from their own perinatal history. Stress response, as 1 consequence of early life adversities, may take its toll on women's reproductive health and their offspring, calling for integrative efforts in preventing early life adversity.

The Living Conditions of Children with Shared Residence - the Swedish Example.

Among children with separated parents, shared residence - i.e., joint physical custody where the child is sharing his or her time equally between two custodial parents' homes - is increasing in many Western countries and is particularly common in Sweden. The overall level of living among children in Sweden is high; however, the potential structural differences between children in various post-separation family arrangements have not been sufficiently studied. Potential risks for children with shared residence relate to the daily hassles and stress when having two homes. This study aims at investigating the living conditions of children with shared residence compared with children living with two custodial parents in the same household and those living with one custodial parent, respectively. Swedish national survey data collected from children aged 10-18 years (n ≈ 5000) and their parents were used. The outcomes were grouped into: Economic and material conditions, Social relations with parents and peers, Health and health behaviors, Working conditions and safety in school and in the neighborhood, and Culture and leisure time activities. Results from a series of linear probability models showed that most outcomes were similar for children with shared residence and those living with two custodial parents in the same household, while several outcomes were worse for children living with one parent. However, few differences due to living arrangements were found regarding school conditions. This study highlights the inequalities in the living conditions of Swedish children, with those living with one parent having fewer resources compared with other children.

Bullying as a Stressor in Mid-Adolescent Girls and Boys-Associations with Perceived Stress, Recurrent Pain, and Salivary Cortisol.

Bullying involves repeated exposure to negative actions while also invoking a power asymmetry between the involved parties. From a stress perspective, being bullied can be seen as a severe and chronic stressor, and an everyday social-evaluative threat, coupled with a shortage of effective social resources for dealing with this particular stressor. The aim of this study was to investigate whether exposure to bullying among mid-adolescent girls and boys is associated with subjective and objective stress-related outcomes in terms of perceived stress, recurrent pain, and salivary cortisol. The data came from the School Stress and Support Study (TriSSS) including students in grades 8-9 in two schools in Stockholm, Sweden, in 2010 (study sample n = 392; cortisol subsample n = 198). Bullying was self-reported and measured by multiple items. The statistical analyses included binary logistic and linear (OLS) regression. Being bullied was associated with greater perceived stress and an increased risk of recurrent pain, among both boys and girls. Also, bullied students had lower cortisol output (AUCG) and lower cortisol awakening response (CARG) as compared to those who were not bullied. Gender-stratified analyses demonstrated that these associations were statistically significant for boys but not for girls. In conclusion, this study demonstrated that being bullied was related to both subjective and objective stress markers among mid-adolescent girls and boys, pointing to the necessity of continuously working against bullying.

ADHD medication in offspring of immigrants - does the income level of the country of parental origin matter?

BACKGROUND: Child psychiatric treatment facilities vary greatly worldwide and are virtually non-existent in many low-income countries. One of the most common psychiatric disorders in childhood is ADHD, with an estimated prevalence of 3-5% in Sweden. Previous studies have shown a similar prevalence of ADHD in minority and majority children in Sweden and the UK. However, clinical studies demonstrated that children from immigrant families living in Sweden received less psychiatric care than those of native-born parents. We tested the hypothesis that the consumption of child psychiatric care in immigrant families would be determined by the availability of such treatment in the parents' country of origin. Patterns of medication for attention-deficit hyperactivity disorder (ADHD) were studied as a proxy for child psychiatric care. METHODS: This was a register study of dispensed stimulant medication during 2013-2014 in Swedish national birth cohorts from 1995-2009. The study population, consisting of nearly 1.4 million children, was divided by national income of the parental country of origin and whether the parents were native Swedes, European immigrants, non-European immigrants or a mixture. Logistic regression was used to calculate the odds ratios of having been dispensed at least one ADHD drug during 2013, with adjustments for gender, family status indicating whether the child is living with both parents, household income and area of residence. RESULTS: Having parents born in low-income (OR [95% confidence interval] 0.27 [0.24-0.29]) or middle-income (European: OR 0.23 [0.20-0.26], non-European: OR 0.39 [0.34-0.41]) countries was associated with lower ADHD treatment levels than having parents born in high-income countries (European: OR 0.60 [0.54-0.66], non-European: OR 0.68 [0.59-0.79]), when compared to children of parents born in Sweden. In families with a background in low or middle income countries, there was no significant association between household income and ADHD medication, while in children with Swedish and mixed backgrounds high level of disposable income was associated with lower levels of ADHD medication. CONCLUSION: The use of child psychiatric care by immigrant families in Sweden was largely associated with the income level of the country of origin.

Teacher Rated School Ethos and Student Reported Bullying-A Multilevel Study of Upper Secondary Schools in Stockholm, Sweden.

School ethos refers to the school leadership's purposive efforts to shape and direct the attitudes, values and behaviors needed in order to promote an active learning environment and to prevent the emergence of undesirable behaviors by creating shared meaning and common goals for the school. The aim of this study was to examine how teacher rated aspects of school ethos are linked with manifestations of bullying among 11th grade students. Five teacher-rated sub-dimensions of school ethos (staff stability, teacher morale, structure-order, student focus, and academic atmosphere) were examined in relation to student-reported perpetration of and exposure to traditional school bullying and cyberbullying. The data material combines student and teacher information from two separate data collections performed in 2016, comprising teachers and students in 58 upper secondary schools in Stockholm. Analyses showed that bullying was associated with all but one of the five sub-dimensions of school ethos, namely structure and order for dealing with bullying behaviors at the school. Results are discussed in light of this counter-intuitive finding. Our findings nevertheless lend support to the idea that the social organization of schools, as reflected in their teacher-rated ethos, can affect individual students' attitudes in a way that prevents the emergence of bullying behavior among students.

School Leadership and Cyberbullying-A Multilevel Analysis.

Cyberbullying is a relatively new form of bullying, with both similarities and differences to traditional bullying. While earlier research has examined associations between school-contextual characteristics and traditional bullying, fewer studies have focused on the links to students' involvement in cyberbullying behavior. The aim of the present study is to assess whether school-contextual conditions in terms of teachers' ratings of the school leadership are associated with the occurrence of cyberbullying victimization and perpetration among students. The data are derived from two separate data collections performed in 2016: The Stockholm School Survey conducted among students in the second grade of upper secondary school (ages 17-18 years) in Stockholm municipality, and the Stockholm Teacher Survey which was carried out among teachers in the same schools. The data include information from 6067 students distributed across 58 schools, linked with school-contextual information based on reports from 1251 teachers. Cyberbullying victimization and perpetration are measured by students' self-reports. Teachers' ratings of the school leadership are captured by an index based on 10 items; the mean value of this index was aggregated to the school level. Results from binary logistic multilevel regression models show that high teacher ratings of the school leadership are associated with less cyberbullying victimization and perpetration. We conclude that a strong school leadership potentially prevents cyberbullying behavior among students.