School environment and mental health in early adolescence - a longitudinal study in Sweden (KUPOL)

BMC Psychiatry, Jul 2016

Background Longitudinal studies indicate strong associations between school proficiency and indicators of mental health throughout adulthood, but the mechanisms of such associations are not fully elucidated. The Kupol study is a prospective cohort study in Sweden set up in order to: (i) describe the association of school pedagogic and social environment and its specific dimensions with the risk of mental ill-health and psychiatric disorders in adolescence; (ii) evaluate the direct effects of school pedagogic and social environment on mental health and the effects mediated by the individual’s academic achievements; and (iii) assess if school pedagogic and social environment are associated with mental ill-health through epigenetic mechanisms, in particular those involving genes regulating the response to stress. Methods The Kupol cohort at baseline consists of 3959 children attending the 7th grade of compulsory school (13–14 years old) in 8 regions of central Sweden in the school years 2013–2014 or 2014–2015. Three follow-up surveys in subsequent years are planned. Teachers’ and students’ perceptions of the culture, climate and ethos of their schools, and students’ mental ill-health are assessed at the whole school level by annual questionnaire surveys. In order to conduct epigenetic analyses saliva specimens are collected from a nested sample of students at inception and two years later. Further, class-, family- and child-level information is collected at baseline and during each year of follow-up. Self-reported information is being complemented with register data via record-linkages to national and regional health and administrative registers. Discussion The topic being investigated is new, and the sample constitutes the largest adolescent cohort in Sweden involved in an ad hoc study. Epigenetic analyses centered on environmental cues to stress response are a thoroughly new approach. Finally a notable feature is the multi-informant and multi-method data collection, with surveys at the school, class, family, and student level. Collaboration and data access: interested investigators should contact the coordinating centre. Additional information is available on the study’s website, http://kupolstudien.se/.

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School environment and mental health in early adolescence - a longitudinal study in Sweden (KUPOL)

Galanti et al. BMC Psychiatry School environment and mental health in early adolescence - a longitudinal study in Sweden (KUPOL) Maria Rosaria Galanti 0 3 Hanna Hultin 2 Christina Dalman 0 3 Karin Engström 0 3 Laura Ferrer-Wreder 1 Yvonne Forsell 0 3 Martin Karlberg 5 Catharina Lavebratt 4 Cecilia Magnusson 0 3 Knut Sundell Jia Zhou 2 Melody Almroth 2 Elena Raffetti 2 0 Department of Public Health Sciences, Centre for Epidemiology and Community Medicine (CES), Stockholm County's Health Care District (SLSO), Karolinska Institutet , Widerströmska Huset, Tomtebodavägen 18a, 17177 Stockholm , Sweden 1 Department of Psychology, Stockholm University , Stockholm , Sweden 2 Department of Public Health Sciences, Karolinska Institutet , Stockholm , Sweden 3 Department of Public Health Sciences, Centre for Epidemiology and Community Medicine (CES), Stockholm County's Health Care District (SLSO), Karolinska Institutet , Widerströmska Huset, Tomtebodavägen 18a, 17177 Stockholm , Sweden 4 Center for Molecular Medicine , Karolinska 5 Department of Education, Uppsala University , Stockholm , Sweden Background: Longitudinal studies indicate strong associations between school proficiency and indicators of mental health throughout adulthood, but the mechanisms of such associations are not fully elucidated. The Kupol study is a prospective cohort study in Sweden set up in order to: (i) describe the association of school pedagogic and social environment and its specific dimensions with the risk of mental ill-health and psychiatric disorders in adolescence; (ii) evaluate the direct effects of school pedagogic and social environment on mental health and the effects mediated by the individual's academic achievements; and (iii) assess if school pedagogic and social environment are associated with mental ill-health through epigenetic mechanisms, in particular those involving genes regulating the response to stress. Methods: The Kupol cohort at baseline consists of 3959 children attending the 7th grade of compulsory school (13-14 years old) in 8 regions of central Sweden in the school years 2013-2014 or 2014-2015. Three follow-up surveys in subsequent years are planned. Teachers' and students' perceptions of the culture, climate and ethos of their schools, and students' mental ill-health are assessed at the whole school level by annual questionnaire surveys. In order to conduct epigenetic analyses saliva specimens are collected from a nested sample of students at inception and two years later. Further, class-, family- and child-level information is collected at baseline and during each year of follow-up. Self-reported information is being complemented with register data via record-linkages to national and regional health and administrative registers. Discussion: The topic being investigated is new, and the sample constitutes the largest adolescent cohort in Sweden involved in an ad hoc study. Epigenetic analyses centered on environmental cues to stress response are a thoroughly new approach. Finally a notable feature is the multi-informant and multi-method data collection, with surveys at the school, class, family, and student level. Collaboration and data access: interested investigators should contact the coordinating centre. Additional information is available on the study's website, http://kupolstudien.se/. School environment; Mental health; Adolescence Background In Sweden, self-reported mental health problems and demand for psychiatric care among adolescents has increased in the last decades, and this is especially true for girls [ 1, 2 ]. Moreover, suicide rates have decreased in Sweden with the exception of the 10–24 age group, and suicide attempts have actually increased among girls in this age group [2]. Alongside the aforementioned trends in mental health problems, a gradual decrease in the literacy level of Swedish students has been noted for several years. According to the Programme for International Student Assessment (PISA), the ranking of Swedish students in the final year of compulsory school has been decreasing in all four assessments conducted between 2000 and 2010 [ 3 ]. Longitudinal studies indicate strong associations between school proficiency and indicators of mental health throughout adulthood, but the mechanisms of such associations are not fully elucidated [ 4–6 ]. In addition, the influence of school pedagogic and social environment as such on adolescents’ mental health is insufficiently investigated, particularly in Sweden. Because of the multiple pathways involved, a singular focus is sometimes placed on what children bring with them when they enter schools (eg., children’s social background) rather than on school environment or the complex interaction between multiple influences. The Kupol study (Swedish acronym for “Knowledge on young people’s mental health and learning”) is a prospective cohort study in Sweden set up in order to investigate changes in adolescent’s mental health in r (...truncated)


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Maria Galanti, Hanna Hultin, Christina Dalman, Karin Engström, Laura Ferrer-Wreder, Yvonne Forsell, Martin Karlberg, Catharina Lavebratt, Cecilia Magnusson, Knut Sundell, Jia Zhou, Melody Almroth, Elena Raffetti. School environment and mental health in early adolescence - a longitudinal study in Sweden (KUPOL), BMC Psychiatry, 2016, pp. 243, 16, DOI: 10.1186/s12888-016-0919-1