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Self-rated mental health and socio-economic background: a study of adolescents in Sweden
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. Affecta psychiatric out-patients clinic, Halmstad, Sweden.ORCID iD: 0000-0002-1324-558X
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Sport Health and Physical activity.ORCID iD: 0000-0002-4218-4499
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.ORCID iD: 0000-0002-3576-2393
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.ORCID iD: 0000-0003-4438-6673
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2014 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 14, no 1, article id 394Article in journal (Refereed) Published
Abstract [en]

Background: Adolescents' mental health is a major public health issue. Previous research has shown that socio-economic factors contribute to the health status of adolescents. The present study explores the association between socio-economic status and self-rated mental health among adolescents.

Methods: Cross sectional data from the Halmstad Youth Quality of Life cohort was collected in a town in Sweden. In all, 948 adolescents (11-13 younger age group and 14-16 older age group) participated. Information on self-rated mental health was collected from the subscale Psychological functioning in the Minneapolis Manchester Quality of Life instrument. The items were summarized into a total score and dichotomized by the mean. Indicators measuring socio-economic status (SES) were collected in a questionnaire using the Family Affluence Scale (FAS) and additional factors regarding parents' marital status and migration were added. Logistic models were used to analyze the data.

Results: Girls were more likely to rate their mental health below the mean compared to boys. With regard to FAS (high, medium, low), there was a significantly increased risk of self-rated mental health below the mean among younger boys in the medium FAS score OR; 2.68 (95% CI 1.35;5.33) and among older boys in the low FAS score OR; 2.37 (1.02;5.52) compared to boys in the high FAS score. No such trend was seen among girls. For younger girls there was a significant protective association between having parents born abroad and self-rated mental health below mean OR: 0.47 (0.24;0.91).

Conclusions: A complex pattern of associations between SES and self-rated mental health, divergent between age and gender groups, was shown. The total FAS score was only associated with boys' self-rated mental health in both age groups, whereas parents' migratory status influenced only the girls' self-rated mental health. Because of the different association for girls' and boys' self-rated mental health and SES, other factors than SES should also be considered when investigating and exploring the mental health of adolescents in affluent communities. © 2014 Hutton et al.; licensee BioMed Central Ltd.

Place, publisher, year, edition, pages
London: BioMed Central, 2014. Vol. 14, no 1, article id 394
Keywords [en]
Adolescents, Self-rated mental health, Socio-economic status, Family affluence scale
National Category
Public Health, Global Health and Social Medicine Nursing
Identifiers
URN: urn:nbn:se:hh:diva-25215DOI: 10.1186/1471-2458-14-394ISI: 000336859500001PubMedID: 24758209Scopus ID: 2-s2.0-84901486949OAI: oai:DiVA.org:hh-25215DiVA, id: diva2:714973
Funder
Swedish Research Council
Note

The study was funded by grants to P S and J N from Region Halland, Halmstad Kommun, Ljungbergska foundation, Länsförsäkringar Halland and to J N from the Swedish Research Council.

Available from: 2014-04-30 Created: 2014-04-30 Last updated: 2025-02-20Bibliographically approved
In thesis
1. Exploring mental health and potential health assets in young people
Open this publication in new window or tab >>Exploring mental health and potential health assets in young people
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Young people in Sweden generally claim to have a good quality of life, but also report increasing mental health problems. It is a concern that only a minority of young people seek and/or access support when encountering mental health problems as mental health is a fundamental human right and integral to a positive development in both childhood and throughout the lifespan. There are uncertainties as to how to facilitate help-seeking and promote mental health among young people and previous studies have often focused on risk-reduction. A shift from a pathological view to a resource-based perspective of mental health can be achieved by adopting a health assets’ approach. This approach also ascribes due emphasis to the fact that mental health is developed within a social context, where both individual and structural health assets, such as the support system, are of importance. With this in mind, the overall aim of this thesis was to explore individual and structural health assets in relation to the mental health of young people.

This thesis is based on four studies using both quantitative (Studies I and II) and qualitative (Study III) methods as well as a scoping review method with a qualitative synthesis (Study IV). Studies I and II had a cross-sectional design and utilized data from self-reported health-related ratings collected in schools in 2011. The association between socio-economic determinants and self-rated mental health in two age groups (11-13 and 14-16) was explored in Study I, and optimism and pessimism as a bi-dimensional construct, and its impact on health-related quality of life and potential to function as a health asset was explored in Study II. In Studies III and IV, the help- seeking process was explored from the perspective of young people, firstly with constructivist grounded theory in Study III based on interviews of young people seeking help for mental health problems within a local setting, and secondly, through a scoping review examination and qualitative synthesis of national and international literature on help-seeking in Study IV.

The results identified potential health assets on both individual and structural levels. The explored health assets on an individual level were socio-economic status and socio-demographic factors (Study I), dispositional optimism (Study II) and individual resources for help-seeking (Studies III and IV), while health assets on a structural level were explored through the experience of and perceptions of young people’s help-seeking process

(Studies III and IV). The individual health assets of socio-economic status and migratory background were seen to affect mental health differently for boys and girls with the boys being susceptible to an accumulation of socio-economic risk factors including family wealth affecting their mental health negatively, and the mental health of the young girls with a migratory background being affected positively (Study I).The individual health asset of optimism was found to be potentially supportive for help-seeking and mental health (Study II). Young people were optimistic about their future but there was a significant decrease in optimism and health-related quality of life, and a significant increase in pessimism, with age. Optimism was independently and positively associated with a high level of health-related quality of life among young people, even when adjusting for parents’ marital status, family country background and gender. Knowledge and a desire for self-reliance were identified as potential individual health assets mainly in regard to the help-seeking process (Studies III and IV). Young people expressed how their knowledge of mental health and the support system was inadequate, rendering a feeling of insecurity, however, they also expressed a strong desire for self-reliance in regard to their mental health. Help-seeking was characterised as a dynamic and psychosocial process without sequentially fixed stages. Potential health assets on a structural level were identified as support through social networks, and a responsive, collective and accessible support system. However, young people perceived the support system as unresponsive, focused on protocol instead of person, fragmented and spread, and lacking in accessibility. The results implied that equipping young people with sufficient knowledge would capitalize on the individual health assets of self-reliance and optimism, conducive to help-seeking and mental health, but that the support system needs to improve in order to meet the particular needs of young people.

Abstract [sv]

Unga människor i Sverige uppger generellt att de har en god livskvalitet. Samtidigt rapporteras om en ökad psykisk ohälsa hos ungdomar vilket gör området till en nationell prioritet. Psykiska problem debuterar ofta i ungdomen och fortsätter in i vuxen ålder. Det är dock få ungdomar som söker hjälp. En stor del av tidigare forskning har ägnats åt ungdomar med psykisk sjukdom, kanske för att dessa är lättare att identifiera än ungdomar som befinner sig i en mer odefinierbar ”gråskala” av psykisk ohälsa. Detta innebär dock att även de som löper en uppbenbar risk för att utveckla psykisk sjukdom hänvisas till egna resurser och nätverk för att ta hand om psykiska problem. För att samhället ska kunna nå ungdomar för hälsofrämjande stöd och insatser, är det av vikt att vi får utökade kunskaper om hur hjälpsökande och psykisk hälsa kan förstärkas. Denna avhandling har utgått från ett resursperspektiv för att öka kunskapen om hur den psykisk hälsan kan främjas hos ungdomar. Ett sådant perspektiv betonar en syn på hälsa där både strukturella och individuella resurser anses samverka för utveckling av psykisk hälsa. Syftet med avhandlingen har varit att utforska individuella och strukturella resurser som kan ha betydelse för ungdomars psykiska hälsa. 

Denna sammanläggningsavhandling bygger på fyra delstudier. Studie I, II och III har utförts inom samma geografiska område, en sydsvensk medelstor tätort. Studie I och II i avhandlingen har använt kvantitativa metoder och är tvärsnittsstudier utifrån data insamlat under hösten 2011 på skolor. Materialet gav en ögonblicksbild av ungdomars självskattade hälsa, livskvalitet och optimism inför framtiden relaterat till individuella faktorer socio-ekonomisk status och socio-demografi. Studie III och IV har utforskat hjälpsökande processen genom två olika metoder; studie III var en kvalitativ intervjustudie med syfte att undersöka hjälpsökande utifrån ungdomars upplevelse och perspektiv, där en konstruktivistisk grundad teori användes. Studie IV var en litteraturstudie – scoping review, också med fokus på ungdomars upplevelse av hjälpsökande, där en kvalitativ, tematisk analys användes, dels för att få en djupare och mer nyanserad förståelse av ungdomars upplevelse av hjälpsökande-processen, men också för att validera fynden från studie III. Potentiella hälsorelaterade resurser identifierades på både individuell och strukturell nivå. Socio-ekonomisk status och sociodemografiska faktorer hade olika samband med psykisk hälsa för pojkar och flickor (studie I). Pojkar verkade vara mer känsliga för faktorer som välstånd och en ansamling av riskfaktorer, med en negativ påverkan på deras psykiska hälsa. Sociodemografiska faktorer utgjorde en resurs för hälsa så till vida att psykisk hälsa hos yngre flickor med utländsk bakgrund påverkades positivt. Optimism befanns vara en potentiell resurs för hälsa hos både pojkar och flickor då optimism hade ett samband med hälso-relaterad livskvalitet oberoende av sociodemografiska faktorer så som kön och bakgrund (studie II). Hjälpsökande processen definierades som en dynamisk och psykosocial process utan fasta steg eller fast ordning (studie III och IV). Ungdomar upplevde hjälpsökande-processen som svårnavigerad och uttryckte en uppfattning att stödsystemet var otillgängligt, fragmenterat och oflexibelt (studie III och IV). De såg vanligtvis inte primärvården som ett lämpligt ställe att söka vård, tyckte att åldersregler var begränsande och ansåg att de var tvungna att söka stöd på flera ställen för att få sina behov tillgodosedda, ofta utifrån medicinska kriterier (studie III och IV). Ungdomar uttryckte också att de hade för lite kunskap om psykisk hälsa och stödsystemet (studie III och IV) och de eftersträvade en självständighet (studie III och IV). Kunskap och självständighet kunde därför ses som möjliga individuella resurser för psykisk hälsa. Likaså kunde stöd från viktiga personer i ungdomars närhet, och personliga nätverk ha stor betydelse för hjälpsökande och psykisk hälsa. 

Föreliggande avhandling bidrar med kunskap om möjliga resurser för att främja ungdomars psykiska hälsa. Ungdomars egna perspektiv på individuella och strukturella faktorer för att främja den psykiska hälsan var ett viktigt bidrag för ökad kunskap inom området. Utifrån ungdomars perspektiv, behöver deras kunskap om psykisk hälsa förstärkas, och de behöver förstå när, hur och var de kan söka hjälp. Optimism hade ett samband med upplevelsen av livskvalitet. Interventioner som är riktade till att öka ungdomars kunskap om psykisk hälsa och stärkande av optimism skulle behöva utvecklas tillsammans med ungdomarna själva, och här är skolan en möjlig arena eftersom man då når alla ungdomar. Ytterligare anpassningar för ungdomars möjlighet att få stöd behövs, t.ex. behöver stöd vara mer lättillgängligt och samlat så att ungdomar inte måste söka vård på flera olika ställen. Stödet behöver vara mer flexibelt, fokuserat på ungdomars individuella situation och personcentrerat.

Place, publisher, year, edition, pages
Halmstad: Halmstad University Press, 2021. p. 106
Series
Halmstad University Dissertations ; 81
Keywords
Mental health, health assets, young people, adolescents, help-seeking, user perspective
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:hh:diva-45811 (URN)978-91-88749-71-0 (ISBN)978-91-88749-72-7 (ISBN)
Public defence
2021-12-03, Baertlingsalen, Kristian IV:s väg 3, Halmstad, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2021-11-04 Created: 2021-11-03 Last updated: 2025-02-20

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