Katja Gillander Gådin

Deliberate self-harm and associated factors in 17-year-old Swedish students:

Background: Deliberate self-harm (DSH) in young people is an important public health issue. To prevent DSH, more knowledge is needed about its prevalence and associated contextual factors in community samples of adolescents. Aims: To determine the prevalence of deliberate self-harm in 17-year-old Swedish students and to explore the association of demographic variables, psychological distress, experiences of violence, and school-related factors with DSH. Methods: Data were derived from a cross-sectional study in which 17-year-old students completed questionnaires during school hours (n = 1,663; 78.3%). The variables used in this analysis are as follows: deliberate self-harm, demographic variables, psychological distress, experiences of violence, and school-related factors. Data were analysed using chi-squared statistics and logistic regression. Results: The lifetime prevalence of DSH was 17%, and it was more common among girls (23.3%) than boys (10.5%). There were considerable socioeconomic differences in reports of DSH. Psychological distress was strongly associated with DSH in both boys and girls, as were experiences of bullying, sexual harassment, physical violence and sexual assault. Social support, safety and academic factors in school were related to reports of DSH in both girls and boys. There were some gender differences with respect to which factors were associated with DSH. Conclusions: Deliberate self-harm is common and more frequently reported by girls than boys. Psychological distress, experiences of different types of violence, and school-related factors (academic, social and safety-related), should be considered risk factors for DSH in young people. Findings can be applied to health-promotion policy and interventions in various contexts, for example schools.

Young students as participants in school health promotion: an intervention study in a Swedish elementary school.

Abstract Objectives. The aim was to analyse if young students could be substantive participants in a healthpromoting school project. The specific aims were to analyse the changes the students proposed in their school environment, how these changes were prioritized by a school health committee and to discuss the students’ proposals and the changes from a health and gender perspective. Study design. An intervention project was carried out in an elementary school with students (about 150) in Grades 1 through 6. The intervention included small-group discussions about health promoting factors, following a health education model referred to as ‘It’s your decision.’ At the last of 6 discussions, the students made suggestions for health-promoting changes in their school environment. A health committee was established with students and staff for the purpose of initiating changes based on the proposals. Methods. A content analysis was used to analyse the proposals and the protocols developed by the health committee. Results. The analysis showed 6 categories of the students’ proposals: social climate, influence on schoolwork, structure and orderliness, security, physical environment and food for well-being. Their priorities corresponded to the students’ categories, but had an additional category regarding health education. Conclusions. Principles that guide promoting good health in schools can be put into action among students as young as those in Grades 1 through 6. Future challenges include how to convey experiences and knowledge to other schools and how to evaluate if inequalities in health because of gender, class and ethnicity can be reduced through the focus on empowerment and participation.

School Health Promotion to Increase Empowerment, Gender Equality and Pupil Participation: A Focus Group Study of a Swedish Elementary School Initiative

A school health promotion project was carried out in an elementary school in Sweden where active participation, gender equality, and empowerment were leading principles. The objective of the study was to understand challenges and to identify social processes of importance for such a project. Focus group interviews were conducted with 6 single-sex groups (7–12 year olds) in grade 1–2, grade 3–4, and grade 5–6 on 2 occasions. The analysis used a grounded theory approach. The analysis identified the core category “normalization processes of violence and harassment.” It is argued that school health promotion initiatives need to be aware of normalization processes of violence and, which may be counter-productive to the increase of empowerment and participation among all pupils.

Violence: Health in Sweden: The National Public Health Report 2012. Chapter 12.

In Sweden and in other countries, it has become increasingly common to view violence from a public health perspective. This chapter presents a description of interpersonal violence with an emphasis on violence in close relations, particularly in partner relationships. According to the Swedish Crime Survey 2010, approximately one in ten inhabitants was exposed to violence, threats or harassment of some kind in 2009. Young people and single mothers with small children are particularly vulnerable to violence. According to Statistics Swedens ULF surveys (Survey on Living Conditions) for 2004-2005, 17 per cent of men and 12 per cent of women aged 16-24 years reported having been subjected to violence or serious threats at some time in the previous 12 months. Boys and men are more frequently subjected to lethal violence and to violence resulting in hospitalisation than girls and women. Similarly, men also make up a majority of the victims of assaults reported to the police. On the other hand, domestic violence and work-related violence more often involve women than men, and sexual violence is chiefly directed at girls and women. Most women and children who are subjected to assault are acquainted with the perpetrator, while this only applies to a minority of male victims. Women are four to five times as likely to be killed by a partner as men. Partner assaults against women, rapes, and gross violations of a womans integrity account for a fifth of all reported crimes of violence (against women and men combined). Violence in partner relationships has significant consequences for physical and mental health; between 12,000 and 14,000 women seek outpatient care each year as a result of violence committed by a partner. Violence can also have serious social repercussions: isolation, financial difficulties, sick leave from work, unemployment, etc., and women subjected to this form of violence can be prevented from seeking medical or other assistance. Children are often involved. Approximately 10 per cent of all children have experienced violence in the home and 5 per cent have experienced it frequently. Many children who witness violence are also beaten themselves. In 2006, the Swedish National Board of Health and Welfare estimated the annual socioeconomic cost of violence against women to be between SEK 2.7 and 3.3 billion, SEK 38 million of which were direct medical costs. Factors affecting the risk of violence in partner relationships are related both to the social structure and individual character of the perpetrator. Trends in violence have moved in different directions. Today, more people in all age groups, with the exception of the most elderly (aged 65-84), report that they have been exposed to threats or violence than in the 1980s. In recent years, however, the increase has halted; there has even been a decline among young people aged 16-24. Crimes of violence reported to the police are growing in number, and the number of reports of work-related violence, for example, has more than doubled since the mid 1970s. The number of rapes reported to the police has also risen significantly in recent year, and the victims are on average becoming younger. Furthermore, rape and gross violation of a womans integrity (combined) are now almost as common as robbery. This increase is probably due to a combination of greater willingness to report crimes, a lower tolerance threshold for violence, legislative changes and an increase in the number of violent acts committed. The rise in violence represented by crime statistics is not reflected in the proportion of people who have suffered serious physical injuries as a result of violence. Over the past ten years, the number of deaths resulting from violence has declined among women and men. Hospital statistics also show that although the percentage of people receiving treatment has remained relatively stable, more people are now seeking hospital treatment following a sexual assault.

Promoting an Equal and Healthy Environment Swedish Students’ Views of Daily Life at School

Education is an important factor in health equity, but many students still do not complete high school. A focus on the school context rather than on individual problems might help to create a supportive environment for health and learning. In this study we explored factors that promote health and learning from the perspective of vocational and low-achieving high school students in Sweden. We used grounded theory with a constructivist orientation, informed and sensitized by the concept of salutogenesis. Students from a school in a mid-sized municipality in Sweden participated, and we collected data using the photovoice method and interviews. Students identified general factors as significant to their well-being and success in school. The main theme, “promoting driving forces for health and learning,” emerged from the categories “longing to be seen by teachers,” “longing for support,” and “longing for recuperation.”

Sexual Harassment of Girls in Elementary School A Concealed Phenomenon Within a Heterosexual Romantic Discourse

The aim of this study was to enhance the understanding of young girls’ experiences of peer sexual harassment in elementary school and of normalizing processes of school-related sexualized violence. Six focus group interviews with girls in Grade 1 through 6 were carried out in an elementary school in the northern part of Sweden. A content analyses showed that young girls experienced verbal, nonverbal, and sexual assault behaviors at school. Sexual harassment as a concealed phenomenon and manifest within a romantic discourse were themes found in the analysis. A conclusion is that schools have to acknowledge behaviors related to sexual harassment as a potential problem even in young ages and develop methods to approach the subject also for this age group.

Seventeen and stressed - Do gender and class matter?

Abstract Despite concerns about stress levels in young people, research about stress and stressors among boys and girls that apply an intersectionality approach is scarce. This cross-sectional study explored gender, class (indicated by academic orientation) and multi-group (gender/class) patterning of perceived stress and reported stressors in a sample of 1,663 17-year-old Swedish students. The students, especially girls, were highly stressed. No class differences were found. Performance-related stressors were predominately indicated by students in academic programmes and girls (regardless of class). Looks-related stress was more common among girls than boys, whilst economic and relational stressors were mostly indicated by vocational programme students, particularly girls. There was a complex gender and class patterning of stress due to demands and lack of money. The interplay of gender and class should be acknowledged in identifying determinants of stress in young people. Possible implications for mental health are discussed.

What students do schools allocate to a cognitive-behavioural intervention? Characteristics of adolescent participants in Northern Sweden

Background Adolescents are a vulnerable group when it comes to the risk of developing depression. Preventing the onset of depressive episodes in this group is therefore a major public health priority. In the last decades, school-based cognitive-behavioural interventions have been a common primary prevention approach. However, evidence on what girls actually are allocated to such interventions when no researchers are involved is scarce. Objective To explore how a selective cognitive-behavioural program (Depression In Swedish Adolescents) developed to prevent depression in adolescents, was implemented in a naturalistic setting in schools in northern part of Sweden. The focus was on characteristics of participants allocated to the intervention. Design Cross-sectional baseline data on depressive symptoms, school environment and socio-economic factors were collected in 2011 by means of questionnaires in schools in a municipality in the northern part of Sweden. Intervention participants were identified in a follow-up questionnaire in 2012. Students (n=288) included in the analyses were in the ages of 14–15. Results Sixty-six girls and no boys were identified as intervention participants. They reported higher levels of depressive symptoms, lower personal relative affluence, more sexual harassment victimization and less peer support compared to female non-participants (n=222). Intervention participants were more likely to attend schools with a higher proportion of low parental education levels and a lower proportion of students graduating with a diploma. Conclusions The developers of the intervention originally intended the program to be universal or selective, but it was implemented as targeted in these schools. It is important for school administrations to adhere to program fidelity when it comes to what students it is aimed for. Implications for effectivenss trials of cognitive-behavioural interventions in the school setting is discussed.Background Adolescents are a vulnerable group when it comes to the risk of developing depression. Preventing the onset of depressive episodes in this group is therefore a major public health priority. In the last decades, school-based cognitive-behavioural interventions have been a common primary prevention approach. However, evidence on what girls actually are allocated to such interventions when no researchers are involved is scarce. Objective To explore how a selective cognitive-behavioural program (Depression In Swedish Adolescents) developed to prevent depression in adolescents, was implemented in a naturalistic setting in schools in northern part of Sweden. The focus was on characteristics of participants allocated to the intervention. Design Cross-sectional baseline data on depressive symptoms, school environment and socio-economic factors were collected in 2011 by means of questionnaires in schools in a municipality in the northern part of Sweden. Intervention participants were identified in a follow-up questionnaire in 2012. Students (n=288) included in the analyses were in the ages of 14–15. Results Sixty-six girls and no boys were identified as intervention participants. They reported higher levels of depressive symptoms, lower personal relative affluence, more sexual harassment victimization and less peer support compared to female non-participants (n=222). Intervention participants were more likely to attend schools with a higher proportion of low parental education levels and a lower proportion of students graduating with a diploma. Conclusions The developers of the intervention originally intended the program to be universal or selective, but it was implemented as targeted in these schools. It is important for school administrations to adhere to program fidelity when it comes to what students it is aimed for. Implications for effectivenss trials of cognitive-behavioural interventions in the school setting is discussed.

Violence Against Young Men and Women A Vital Health Issue

Objectives: Violence is regarded as a major health issue in an increasing amount of literature and is known as an important factor in womens ill health. Little however is known about violence against young men and women and its impact on their health. The principal aim of this study was to analyze health outcomes and health care utilization as reported among men and women aged 18-25 exposed and not exposed to physical and/or emotional violence. Study design: A cross-sectional national health survey in Sweden. Methods: Postal questionnaires were sent to nearly 3,000 men and women. Three questions were used to ask about violence. Sociodemographic characteristics for those exposed to violence during the past 12 months were analyzed and compared to those not exposed. Crude and adjusted odds ratios were calculated for health outcomes and medical care utilization. Results: Increased odds ratios were found for most health outcomes, and health care utilization for those exposed to violence compared to non-exposed. After adjusting for socioeconomic factors, smoking, and use of alcohol and cannabis, most variables were principally unchanged for women but considerably lower for men. Socioeconomic factors, smoking, and the use of drugs were all correlated to victimization. Conclusions: A strong association between those exposed to violence and physical and mental ill health was demonstrated also after adjusting for possible confounders, specifically for women. It is time to include questions about violence in public health questionnaires aimed at young people, but also to start asking about it more frequently in health care settings.

Self-rated health among young Europeans not in employment, education or training - with a focus on the conventionally unemployed and the disengaged

NEET is an acronym for Not in Employment, Education or Training. For the year 2010, it is estimated that 12.5% of all young people aged 15–24 in the OECD countries could be categorised as NEETs. Within this group, various subgroups of NEET are identified. Our study, which was conducted using cross-sectional data collected through the European Social Survey, focuses on the category of people who are assumed to be most marginalised and inactive: “the disengaged.” Participants in the study were men and women aged 18–30, originating from 33 European countries. The results show that disengaged NEETs reported poorer health than both young people who were conventionally unemployed and those in employment or studying. It is also shown that “the disengaged” scored worse on other social and welfare variables, for example, trust and social activity. Being disengaged is discussed in relation to the gross domestic products of the different countries.