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Association between adolescents’ academic aspirations and expectations and mental health: a one-year follow-up study

Association between adolescents’ academic aspirations and expectations and mental health: a... Abstract Background Mental health problems among youth have increased in Sweden in recent decades, as has competition in higher education and the labour market. It is unknown whether the increasing emphasis put on educational achievement might negatively affect adolescents’ mental health. We aimed to investigate the relationship between adolescents’ academic aspirations and expectations and the risk of mental health problems. Methods We studied 3343 Swedish 7th grade adolescents (age 13), who participated in the first two waves of the KUPOL longitudinal study; participants answered a questionnaire encompassing the five-item Future Aspirations and Goals (FG) subscale of the Student Engagement Instrument, two questions about their own academic aspirations and expectations and two mental health instruments: the Center for Epidemiological studies for Children (CES-DC) (α=.90) and the Strengths and Difficulties Questionnaire (SDQ) (α=.78). The association between aspirations and expectations at baseline and mental health at follow-up was analysed using logistic regression models adjusting for baseline mental health, socio-demographic and family factors. Results The FG subscale was inversely and linearly associated with the odds of high CES-DC score [adjusted OR (odds ratio) 0.71, 95% CI (confidence interval): 0.59–0.86], total Strengths and Difficulties Questionnaire score (OR 0.59, 95% CI 0.49–0.71), and its internalizing (OR 0.70, 95% CI 0.59–0.84) and externalizing problems scores (OR 0.58, 95% CI 0.48–0.71). Conclusions Adolescents with high individual academic aspirations have less mental health problems at 1-year follow-up. Future studies should investigate whether interventions aimed at increasing aspirations and engagement in school may prevent mental health problems in adolescence. Introduction Mental health problems are the largest contributor to morbidity among adolescents and young adults globally,1 and have increased among adolescents in many high-income countries during recent decades, especially internalizing problems among girls.2 In Sweden this increase has been particularly steep.3 Early adolescence (age 10–14) is a phase of life marked not only by an increase in the rate of mental health problems,4 but also by an increase in perceived school pressure5 paired with a decreased interest in school.6 It is an important time when young people develop decision making skills and begin making plans about their futures.7 During the last decades Sweden has faced several controversial changes to the academic system with lasting effects today. The most important policy changes concern the shift of the responsibility for the school system from the state to the municipal level, and the introduction and spread of state funded but privately run ‘free schools’, and an increase in students’ responsibility for their own education.8 These changes are thought to have increased competition both between schools and students.9 Acceptance into higher education and the labour market have both become more competitive in Sweden.10 An increasing number of jobs require a university degree,11 and educational achievement is considered the most important means for young people to improve their opportunities for labour market participation and life circumstances.12 The increasing importance of education for future prospects may influence aspirations regarding academic achievement starting at a young age. Both high and low academic aspirations may have an impact on young people’s mental health through different conceivable pathways. High aspirations nurture strong engagement with school in some cases, which is associated with psychological processes that promote autonomy and positive functioning,13 and ultimately has a positive impact on mental health. Furthermore, low aspirations may be related to academic futility and disengagement in school, which may influence mental health negatively. On the other hand, high aspirations have been found to be associated with stress,14 maladaptive perfectionism15 and even depression and suicide ideation.16 Reverse causation is also possible (i.e. poor mental health may influence an individual’s aspirations). Alternatively, the relationship may be bi-directional in that aspirations and poor mental health reinforce each other over time. Academic aspirations refer to how far a person would like to go in their education, while expectations refer to how far a person believes he/she will go in education.17 While the concepts are similar, and sometimes used interchangeably, some authors have suggested that they are representative of slightly different processes and may not always be aligned.17 The majority of literature on the topic of academic aspirations or expectations focuses on achievement rather than mental health outcomes. One US study found that unmet educational expectations did not predict depression later in life.18 However, this study was initiated in the 1970s and as mentioned previously, trends in mental health and higher education have changed since. To the best of our knowledge, no longitudinal studies in Europe have explored the relationship between students’ own academic aspirations and mental health problems. We investigated whether adolescents’ own academic aspirations are associated with different dimensions of poor mental health, and whether aspirations and expectations relate differently to mental health, in a large longitudinal study of Swedish adolescents. Methods Study population This study is based on the KUPOL cohort study, a complete description of which has previously been published,19 and will be summarized here. Five hundred and forty-one schools were contacted in 2013 from 8 regions of central Sweden. Of these, 101 (62 public and 39 private) participated in the study. Students in 7th grade (age 13) were considered eligible except those with severe learning disabilities or poor comprehension of the Swedish language. Baseline data were collected at two time-points, i.e. in the 2013–14 and the 2014–15 academic years, resulting in two subsequent cohorts of 7th grade students. Follow-up data were collected in the following academic year for each sub-cohort. In total 3343 students answered both baseline and follow-up questionnaires, making this the analytical sample for this study. Compared to the corresponding Swedish average, schools in our sample were more likely to be private schools, to have lower rates of teachers with a university degree and to have lower rates of students whose parents were born outside the country.19 The KUPOL study was approved by the Stockholm Ethics Review Board (reference numbers: 2012/1904-31/1 and 2016/1280-32). Measures Data were collected through questionnaires given to the students and their parents or guardians at baseline and at one year follow-up. Predictors Future aspirations and goals were measured at baseline using the ‘Future aspirations and Goals’ (FG) five-item subscale of the Student Engagement Instrument (SEI).13,20 The SEI measures aspects of cognitive and psychological engagement in school and has shown satisfactory internal validity in multiple contexts.13,20 The five items of the FG subscale measure aspirations and perceived importance for continued education, the value put on education and hopefulness about the future. Response alternatives are scored on a 5-point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’, and the total score is calculated as the mean of the five questions.21 High internal consistency, and correlation with academic outcomes in the expected directions, has previously been found for the FG subscale:15 its Cronbach alpha in our study was .79. In addition to using the FG subscale as a continuous measure, we categorized the upper and lower quartiles of the FG score to investigate the separate effects of very high and very low scores. Students also answered two questions about specific academic expectations and aspirations at baseline which were adapted from the Positive Youth Development 4-H study.22 These two questions ask how far in their education participants would (1) like to and (2) believe they will go, respectively. Response alternatives were ‘I don’t know’, ‘vocational high school’, ‘high school theoretical track’ and ‘university’. We combined the high school tracks into one category. High school (upper secondary school after the age of 16) is not mandatory in Sweden; therefore, students can choose whether or not they want to continue their education after compulsory school, and if so, which track they would like to focus on. The number of participants with a mismatch between aspirations and expectations was too limited to allow investigation of the discrepancies between these two measures; therefore, these specific expectations and aspirations questions were analysed separately in order to investigate whether they related to mental health differently. Outcomes Mental health was measured at baseline and at 1-year follow-up with the Swedish versions of the Centre for Epidemiological Studies Depression scale for Children (CES-DC) and the Strengths and Difficulties Questionnaire (SDQ). Both scales have been extensively validated in Sweden23,24 and internationally.25,26 The CES-DC is a 20-item scale suitable for screening for depressive disorder in young people aged 6–17.23 Each question refers to how often the child experienced a certain symptom in the past week. The four possible response alternatives range from ‘not at all’ to ‘a lot’. The recommended cut-off point of the CES-DC for screening for depressive disorder among adolescents of a score of at least 30 out of 60 points was used to create a binary outcome.23 The scale’s Cronbach alpha was .90. The SDQ is a 25-item scale useful in screening for conduct disorder, hyperactivity, depression and anxiety disorders.26 The scale consists of five subscales representing different areas of psychological strengths and difficulties, labelled as: emotional problems, conduct problems, hyperactivity, peer problems and pro-social behaviour. However, it is recommended in studies of community samples to combine emotional problems and peer problems to derive an internalizing problems subscale, and conduct problems and hyperactivity to derive an externalizing problems subscale.27 Together, the internalizing and externalizing subscales make up the total difficulties scale. The response alternatives are ‘not true’, ‘somewhat true’ and ‘certainly true’. We categorized these scales according to their recommended cut-off points indicating a high or very high score:27,28 these cut-offs are 18 out of 40 for the total difficulties scale,27 9 out of 20 for the internalizing and 11 out of 20 for the externalizing problems subscales.26 The Cronbach’s alphas for the SDQ scales were .78 for the total difficulties scale, .71 for the internalizing problems scale and .73 for the externalizing problems scale. Covariates Information on the child’s living arrangements were obtained from the child’s baseline questionnaire and classified as ‘living’ vs. ‘not living with both parents’, Parents’ birth country [categorized as ‘at least one parent born in Sweden’ (yes/no)], employment [‘both parents employed’ (yes/no)] and education [‘at least one parent with university education’ (yes/no)] were obtained from the parents’ reports at baseline. For the baseline SDQ scales, we used the recommended four-band categorization, and applied the same distribution to derive categories for the CES-DC.27 Statistical analysis We first explored the cluster effect of schools through multi-level modelling with random intercept. The model test statistic (−2 log likelihood) was virtually identical to that obtained through ordinary regression, indicating a negligible effect of student clustering within schools. Therefore, we carried out the analysis ignoring the clustering of the observations. We analysed the distribution of the baseline covariates according to SDQ total difficulties and CES-DC scores at 1-year follow-up using Chi-square tests. As the mental health variables were not normally distributed and we could not normalize them, we investigated the associations between different measures of academic expectations and aspirations and mental health problems using logistic regression. Since we hypothesized that both very high and very low aspirations could increase the risk of mental health problems, we first investigated the association between the categorical FG variable and the four measures of mental ill-health. Tests of linearity suggested a linear relationship between the FG subscale and the measures of mental health, thus, in all further analyses we included the FG scale as both a continuous and categorical variable. We fitted models for measures of baseline academic aspirations and expectations and each measure of mental health at follow up, both unadjusted (model 1), and adjusted for baseline mental health, sex of the child, child’s living arrangement, parents’ employment, parents’ education and parents’ country of birth (model 2). The reason for considering these factors as confounders is that they may be associated with both aspirations and expectations and have been shown to be associated with poor mental health,29 but they are not in the causal pathway between exposure and outcome. We hypothesized that poor mental health at baseline, sex (because there are indicators that girls may have higher academic aspirations than boys30) low parental socioeconomic status (measured by education and employment) having immigrant parents (which could render some difficulties in navigating the Swedish school system) may hamper development of high academic aspirations. Approximately 11% of study participants in the analytical sample had missing information on at least one of the covariates. As a sensitivity analysis, we built logistic regression models to compare differences in results from multiple imputed datasets and after pairwise deletion. This analysis indicated that associations and standard errors differed only marginally between these two approaches; therefore, results are presented without imputation. Effect modification by gender and baseline mental health was investigated using stratified analysis and by formal tests of interaction. Analyses were conducted using SAS Enterprise Guide 7.1. Results Participants with high scores on the CES-DC and SDQ total difficulties scales at follow-up were more likely to be girls, not living with both of their parents, having parents with only basic or secondary education, at least one unemployed parent and a higher CES-DC or SDQ score at baseline compared to those with scores within the normal range (table 1). Table 1 Characteristics of the study population at baseline according to CES-DC and SDQ scores at follow up N (%) CES-DC SDQ ≥30 (N = 401) <30 (N = 2911) Pa ≥18 (N = 362) <18 (N = 2955) Pa N (%) N (%) N (%) N (%) Sex Boys 1599 (47.83) 61 (15.21) 1524 (52.35) 121 (33.43) 1462 (49.48) Girls 1744 (52.17) 340 (84.79) 1387 (47.65) <.001 241 (66.57) 1493 (50.52) <.001 Living arrangement Lives with both parents 3125 (93.56) 361 (90.02) 2736 (94.09) 318 (87.85) 2784 (94.31) Lives with only one or neither parent 215 (6.44) 40 (9.98) 172 (5.91) .002 44 (12.15) 168 (5.69) <.001 Missing 3 Parents’ education One or both went to university 2234 (69.10) 251 (64.19) 1964 (69.82) 194 (54.96) 2021 (70.81) Neither went to university 999 (30.90) 140 (35.81) 849 (30.18) .024 159 (45.04) 833 (29.19) <.001 Missing 110 Parents’ employment Both employed 2722 (85.52) 313 (81.72) 2387 (86.05) 276 (80.23) 2425 (86.18) One or both unemployed 461 (14.48) 70 (18.28) 387 (13.95) .017 68 (19.77) 389 (13.82) .003 Missing 160 Parents’ birth country At least one parent born in Sweden 2970 (91.84) 360 (93.02) 2585 (91.73) 320 (91.69) 2629 (91.96) Neither parent born in Sweden 264 (8.16) 27 (6.98) 233 (8.27) .383 29 (8.31) 230 (8.04) .864 Missing 109 Baseline CES-DC Average 2642 (80.21) 147 (37.22) 2475 (86.24) 161 (45.10) 2462 (84.55) Raised 351 (10.66) 96 (24.30) 248 (8.64) 71 (19.89) 276 (9.48) High 146 (4.43) 59 (14.94) 86 (3.00) 52 (14.57) 93 (3.19) Very high 155 (4.71) 93 (23.54) 61 (2.13) <.001 73 (20.45) 81 (2.78) <.001 Missing 49 Baseline SDQ Average 2728 (82.52) 204 (51.78) 2496 (86.64) 141 (39.50) 2563 (87.68) Raised 308 (9.32) 78 (19.80) 228 (7.91) 77 (21.57) 230 (7.87) High 109 (3.30) 39 (9.90) 69 (2.40) 44 (12.32) 65 (2.22) Very high 161 (4.87) 73 (18.53) 88 (3.05) <.001 95 (26.61) 65 (2.22) <.001 Missing 37 N (%) CES-DC SDQ ≥30 (N = 401) <30 (N = 2911) Pa ≥18 (N = 362) <18 (N = 2955) Pa N (%) N (%) N (%) N (%) Sex Boys 1599 (47.83) 61 (15.21) 1524 (52.35) 121 (33.43) 1462 (49.48) Girls 1744 (52.17) 340 (84.79) 1387 (47.65) <.001 241 (66.57) 1493 (50.52) <.001 Living arrangement Lives with both parents 3125 (93.56) 361 (90.02) 2736 (94.09) 318 (87.85) 2784 (94.31) Lives with only one or neither parent 215 (6.44) 40 (9.98) 172 (5.91) .002 44 (12.15) 168 (5.69) <.001 Missing 3 Parents’ education One or both went to university 2234 (69.10) 251 (64.19) 1964 (69.82) 194 (54.96) 2021 (70.81) Neither went to university 999 (30.90) 140 (35.81) 849 (30.18) .024 159 (45.04) 833 (29.19) <.001 Missing 110 Parents’ employment Both employed 2722 (85.52) 313 (81.72) 2387 (86.05) 276 (80.23) 2425 (86.18) One or both unemployed 461 (14.48) 70 (18.28) 387 (13.95) .017 68 (19.77) 389 (13.82) .003 Missing 160 Parents’ birth country At least one parent born in Sweden 2970 (91.84) 360 (93.02) 2585 (91.73) 320 (91.69) 2629 (91.96) Neither parent born in Sweden 264 (8.16) 27 (6.98) 233 (8.27) .383 29 (8.31) 230 (8.04) .864 Missing 109 Baseline CES-DC Average 2642 (80.21) 147 (37.22) 2475 (86.24) 161 (45.10) 2462 (84.55) Raised 351 (10.66) 96 (24.30) 248 (8.64) 71 (19.89) 276 (9.48) High 146 (4.43) 59 (14.94) 86 (3.00) 52 (14.57) 93 (3.19) Very high 155 (4.71) 93 (23.54) 61 (2.13) <.001 73 (20.45) 81 (2.78) <.001 Missing 49 Baseline SDQ Average 2728 (82.52) 204 (51.78) 2496 (86.64) 141 (39.50) 2563 (87.68) Raised 308 (9.32) 78 (19.80) 228 (7.91) 77 (21.57) 230 (7.87) High 109 (3.30) 39 (9.90) 69 (2.40) 44 (12.32) 65 (2.22) Very high 161 (4.87) 73 (18.53) 88 (3.05) <.001 95 (26.61) 65 (2.22) <.001 Missing 37 SDQ, Strengths and Difficulties Questionnaire; CES-DC, Centre for Epidemiological Studies Depression scale for Children. a P-values correspond to Chi-square test comparing the distribution of the independent variables according to the SDQ and CES-DC categories. Table 1 Characteristics of the study population at baseline according to CES-DC and SDQ scores at follow up N (%) CES-DC SDQ ≥30 (N = 401) <30 (N = 2911) Pa ≥18 (N = 362) <18 (N = 2955) Pa N (%) N (%) N (%) N (%) Sex Boys 1599 (47.83) 61 (15.21) 1524 (52.35) 121 (33.43) 1462 (49.48) Girls 1744 (52.17) 340 (84.79) 1387 (47.65) <.001 241 (66.57) 1493 (50.52) <.001 Living arrangement Lives with both parents 3125 (93.56) 361 (90.02) 2736 (94.09) 318 (87.85) 2784 (94.31) Lives with only one or neither parent 215 (6.44) 40 (9.98) 172 (5.91) .002 44 (12.15) 168 (5.69) <.001 Missing 3 Parents’ education One or both went to university 2234 (69.10) 251 (64.19) 1964 (69.82) 194 (54.96) 2021 (70.81) Neither went to university 999 (30.90) 140 (35.81) 849 (30.18) .024 159 (45.04) 833 (29.19) <.001 Missing 110 Parents’ employment Both employed 2722 (85.52) 313 (81.72) 2387 (86.05) 276 (80.23) 2425 (86.18) One or both unemployed 461 (14.48) 70 (18.28) 387 (13.95) .017 68 (19.77) 389 (13.82) .003 Missing 160 Parents’ birth country At least one parent born in Sweden 2970 (91.84) 360 (93.02) 2585 (91.73) 320 (91.69) 2629 (91.96) Neither parent born in Sweden 264 (8.16) 27 (6.98) 233 (8.27) .383 29 (8.31) 230 (8.04) .864 Missing 109 Baseline CES-DC Average 2642 (80.21) 147 (37.22) 2475 (86.24) 161 (45.10) 2462 (84.55) Raised 351 (10.66) 96 (24.30) 248 (8.64) 71 (19.89) 276 (9.48) High 146 (4.43) 59 (14.94) 86 (3.00) 52 (14.57) 93 (3.19) Very high 155 (4.71) 93 (23.54) 61 (2.13) <.001 73 (20.45) 81 (2.78) <.001 Missing 49 Baseline SDQ Average 2728 (82.52) 204 (51.78) 2496 (86.64) 141 (39.50) 2563 (87.68) Raised 308 (9.32) 78 (19.80) 228 (7.91) 77 (21.57) 230 (7.87) High 109 (3.30) 39 (9.90) 69 (2.40) 44 (12.32) 65 (2.22) Very high 161 (4.87) 73 (18.53) 88 (3.05) <.001 95 (26.61) 65 (2.22) <.001 Missing 37 N (%) CES-DC SDQ ≥30 (N = 401) <30 (N = 2911) Pa ≥18 (N = 362) <18 (N = 2955) Pa N (%) N (%) N (%) N (%) Sex Boys 1599 (47.83) 61 (15.21) 1524 (52.35) 121 (33.43) 1462 (49.48) Girls 1744 (52.17) 340 (84.79) 1387 (47.65) <.001 241 (66.57) 1493 (50.52) <.001 Living arrangement Lives with both parents 3125 (93.56) 361 (90.02) 2736 (94.09) 318 (87.85) 2784 (94.31) Lives with only one or neither parent 215 (6.44) 40 (9.98) 172 (5.91) .002 44 (12.15) 168 (5.69) <.001 Missing 3 Parents’ education One or both went to university 2234 (69.10) 251 (64.19) 1964 (69.82) 194 (54.96) 2021 (70.81) Neither went to university 999 (30.90) 140 (35.81) 849 (30.18) .024 159 (45.04) 833 (29.19) <.001 Missing 110 Parents’ employment Both employed 2722 (85.52) 313 (81.72) 2387 (86.05) 276 (80.23) 2425 (86.18) One or both unemployed 461 (14.48) 70 (18.28) 387 (13.95) .017 68 (19.77) 389 (13.82) .003 Missing 160 Parents’ birth country At least one parent born in Sweden 2970 (91.84) 360 (93.02) 2585 (91.73) 320 (91.69) 2629 (91.96) Neither parent born in Sweden 264 (8.16) 27 (6.98) 233 (8.27) .383 29 (8.31) 230 (8.04) .864 Missing 109 Baseline CES-DC Average 2642 (80.21) 147 (37.22) 2475 (86.24) 161 (45.10) 2462 (84.55) Raised 351 (10.66) 96 (24.30) 248 (8.64) 71 (19.89) 276 (9.48) High 146 (4.43) 59 (14.94) 86 (3.00) 52 (14.57) 93 (3.19) Very high 155 (4.71) 93 (23.54) 61 (2.13) <.001 73 (20.45) 81 (2.78) <.001 Missing 49 Baseline SDQ Average 2728 (82.52) 204 (51.78) 2496 (86.64) 141 (39.50) 2563 (87.68) Raised 308 (9.32) 78 (19.80) 228 (7.91) 77 (21.57) 230 (7.87) High 109 (3.30) 39 (9.90) 69 (2.40) 44 (12.32) 65 (2.22) Very high 161 (4.87) 73 (18.53) 88 (3.05) <.001 95 (26.61) 65 (2.22) <.001 Missing 37 SDQ, Strengths and Difficulties Questionnaire; CES-DC, Centre for Epidemiological Studies Depression scale for Children. a P-values correspond to Chi-square test comparing the distribution of the independent variables according to the SDQ and CES-DC categories. In multivariate models, the continuous FG scale was linearly and inversely associated with the odds of high CES-DC [odds ratio (OR) 0.71, 95% confidence intervals (CI) 0.59–0.86], SDQ total difficulties (OR 0.59, 95% CI 0.49–0.71), SDQ internalizing (OR 0.79, 95% CI 0.59–0.84) and SDQ externalizing (OR 0.58 95% CI 0.48–0.71) scores. Results tended to be similar when the categorical FG scale was used, albeit precision was lower (tables 2 and 3). Table 2 Odds ratios and 95% confidence intervals for depressive symptoms at follow-up, according to measures of baseline academic aspirations or expectations CES-DC score ≥30 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.54 (0.47–0.62) 0.71 (0.59–0.86) FG categorical Low 158/809 1.85 (1.46–2.34) 1.49 (1.12–2.00) Medium 167/1437 1 1 High 72/1022 0.58 (0.43–0.77) 0.73 (0.52–1.00) Aspirations Don’t know 157/1328 1.07 (0.84–1.35) 1.16 (0.87–1.54) High school only 83/539 1.45 (1.09–1.93) 1.53 (1.07–2.17) University 152/1362 1 1 Expectations Don’t know 200/1535 1.43 (1.11–1.84) 1.33 (0.99–1.79) High school only 88/636 1.53 (1.13–2.08) 1.32 (0.92–1.90) University 100/1054 1 1 CES-DC score ≥30 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.54 (0.47–0.62) 0.71 (0.59–0.86) FG categorical Low 158/809 1.85 (1.46–2.34) 1.49 (1.12–2.00) Medium 167/1437 1 1 High 72/1022 0.58 (0.43–0.77) 0.73 (0.52–1.00) Aspirations Don’t know 157/1328 1.07 (0.84–1.35) 1.16 (0.87–1.54) High school only 83/539 1.45 (1.09–1.93) 1.53 (1.07–2.17) University 152/1362 1 1 Expectations Don’t know 200/1535 1.43 (1.11–1.84) 1.33 (0.99–1.79) High school only 88/636 1.53 (1.13–2.08) 1.32 (0.92–1.90) University 100/1054 1 1 OR, odds ratio; CI, confidence interval; CES–DC, Centre for Epidemiological Studies Depression Scale for Children; FG, Future Aspirations and Goals subscale. a Model 1 is unadjusted. b Model 2 is adjusted for baseline mental health, sex of the child, living arrangement, parental education, parental employment, and parents’ birth country. Table 2 Odds ratios and 95% confidence intervals for depressive symptoms at follow-up, according to measures of baseline academic aspirations or expectations CES-DC score ≥30 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.54 (0.47–0.62) 0.71 (0.59–0.86) FG categorical Low 158/809 1.85 (1.46–2.34) 1.49 (1.12–2.00) Medium 167/1437 1 1 High 72/1022 0.58 (0.43–0.77) 0.73 (0.52–1.00) Aspirations Don’t know 157/1328 1.07 (0.84–1.35) 1.16 (0.87–1.54) High school only 83/539 1.45 (1.09–1.93) 1.53 (1.07–2.17) University 152/1362 1 1 Expectations Don’t know 200/1535 1.43 (1.11–1.84) 1.33 (0.99–1.79) High school only 88/636 1.53 (1.13–2.08) 1.32 (0.92–1.90) University 100/1054 1 1 CES-DC score ≥30 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.54 (0.47–0.62) 0.71 (0.59–0.86) FG categorical Low 158/809 1.85 (1.46–2.34) 1.49 (1.12–2.00) Medium 167/1437 1 1 High 72/1022 0.58 (0.43–0.77) 0.73 (0.52–1.00) Aspirations Don’t know 157/1328 1.07 (0.84–1.35) 1.16 (0.87–1.54) High school only 83/539 1.45 (1.09–1.93) 1.53 (1.07–2.17) University 152/1362 1 1 Expectations Don’t know 200/1535 1.43 (1.11–1.84) 1.33 (0.99–1.79) High school only 88/636 1.53 (1.13–2.08) 1.32 (0.92–1.90) University 100/1054 1 1 OR, odds ratio; CI, confidence interval; CES–DC, Centre for Epidemiological Studies Depression Scale for Children; FG, Future Aspirations and Goals subscale. a Model 1 is unadjusted. b Model 2 is adjusted for baseline mental health, sex of the child, living arrangement, parental education, parental employment, and parents’ birth country. Table 3 Odds ratios and 95% confidence intervals for mental health problems at follow-up measured by the Strength and Difficulties Questionnaire according to measures of baseline academic aspirations or expectations SDQ total difficulties ≥18 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.41 (0.35–0.48) 0.59 (0.49–0.71) FG categorical Low 161/806 2.30 (1.80–2.94) 1.54 (1.15–2.07) Medium 141/1439 1 1 High 55/1028 0.52 (0.38–0.72) 0.68 (0.48–0.97) Aspirations Don’t know 159/1327 1.44 (1.12–1.86) 1.40 (1.03–1.89) High school only 74/538 1.69 (1.24–2.30) 1.33 (0.91–1.94) University 118/1369 1 1 Expectations Don’t know 188/1534 1.68 (1.28–2.21) 1.32 (0.96–1.82) High school only 80/638 1.73 (1.25–2.39) 1.16 (0.79–1.70) University 81/1057 1 1 Internalizing problems score ≥9 FG subscale 0.58 (0.51–0.67) 0.70 (0.59–0.84) FG categorical Low 177/808 1.67 (1.34–2.09) 1.48 (1.13–1.94) Medium 207/1441 1 1 High 103/1028 0.66 (0.52–0.85) 0.93 (0.70–1.24) Aspirations Don’t know 199/1328 1.04 (0.84–1.29) 1.07 (0.82–1.38) High school only 84/539 1.09 (0.83–1.44) 1.14 (0.82–1.59) University 198/1370 1 1 Expectations Don’t know 250/1536 1.32 (1.05–1.65) 1.22 (0.93–1.59) High school only 93/638 1.16 (0.87–1.54) 1.00 (0.71–1.40) University 136/1058 1 1 Externalizing problems score ≥11 FG subscale 0.40 (0.34–0.47) 0.58 (0.48–0.71) FG categorical Low 139/806 2.95 (2.24–3.89) 1.93 (1.39–2.69) Medium 95/1440 1 1 High 41/1028 0.59 (0.40–0.86) 0.65 (0.43–0.99) Aspirations Don’t know 119/1328 1.47 (1.10–1.96) 1.32 (0.93–1.86) High school only 63/538 1.98 (1.41–2.79) 1.34 (0.88–2.05) University 86/1369 1 1 Expectations Don’t know 146/1535 1.78 (1.30–2.43) 1.42 (0.98–2.04) High school only 60/638 1.76 (1.21–2.55) 1.10 (0.71–1.71) University 59/1057 1 1 SDQ total difficulties ≥18 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.41 (0.35–0.48) 0.59 (0.49–0.71) FG categorical Low 161/806 2.30 (1.80–2.94) 1.54 (1.15–2.07) Medium 141/1439 1 1 High 55/1028 0.52 (0.38–0.72) 0.68 (0.48–0.97) Aspirations Don’t know 159/1327 1.44 (1.12–1.86) 1.40 (1.03–1.89) High school only 74/538 1.69 (1.24–2.30) 1.33 (0.91–1.94) University 118/1369 1 1 Expectations Don’t know 188/1534 1.68 (1.28–2.21) 1.32 (0.96–1.82) High school only 80/638 1.73 (1.25–2.39) 1.16 (0.79–1.70) University 81/1057 1 1 Internalizing problems score ≥9 FG subscale 0.58 (0.51–0.67) 0.70 (0.59–0.84) FG categorical Low 177/808 1.67 (1.34–2.09) 1.48 (1.13–1.94) Medium 207/1441 1 1 High 103/1028 0.66 (0.52–0.85) 0.93 (0.70–1.24) Aspirations Don’t know 199/1328 1.04 (0.84–1.29) 1.07 (0.82–1.38) High school only 84/539 1.09 (0.83–1.44) 1.14 (0.82–1.59) University 198/1370 1 1 Expectations Don’t know 250/1536 1.32 (1.05–1.65) 1.22 (0.93–1.59) High school only 93/638 1.16 (0.87–1.54) 1.00 (0.71–1.40) University 136/1058 1 1 Externalizing problems score ≥11 FG subscale 0.40 (0.34–0.47) 0.58 (0.48–0.71) FG categorical Low 139/806 2.95 (2.24–3.89) 1.93 (1.39–2.69) Medium 95/1440 1 1 High 41/1028 0.59 (0.40–0.86) 0.65 (0.43–0.99) Aspirations Don’t know 119/1328 1.47 (1.10–1.96) 1.32 (0.93–1.86) High school only 63/538 1.98 (1.41–2.79) 1.34 (0.88–2.05) University 86/1369 1 1 Expectations Don’t know 146/1535 1.78 (1.30–2.43) 1.42 (0.98–2.04) High school only 60/638 1.76 (1.21–2.55) 1.10 (0.71–1.71) University 59/1057 1 1 OR, odds ratio; CI, confidence interval; SDQ, Strengths and Difficulties questionnaire; FG, Future Aspirations and Goals subscale. a Model 1 is unadjusted. b Model 2 is adjusted for baseline mental health, sex of the child, living arrangement, parental education, parental employment, and parents’ birth country. Table 3 Odds ratios and 95% confidence intervals for mental health problems at follow-up measured by the Strength and Difficulties Questionnaire according to measures of baseline academic aspirations or expectations SDQ total difficulties ≥18 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.41 (0.35–0.48) 0.59 (0.49–0.71) FG categorical Low 161/806 2.30 (1.80–2.94) 1.54 (1.15–2.07) Medium 141/1439 1 1 High 55/1028 0.52 (0.38–0.72) 0.68 (0.48–0.97) Aspirations Don’t know 159/1327 1.44 (1.12–1.86) 1.40 (1.03–1.89) High school only 74/538 1.69 (1.24–2.30) 1.33 (0.91–1.94) University 118/1369 1 1 Expectations Don’t know 188/1534 1.68 (1.28–2.21) 1.32 (0.96–1.82) High school only 80/638 1.73 (1.25–2.39) 1.16 (0.79–1.70) University 81/1057 1 1 Internalizing problems score ≥9 FG subscale 0.58 (0.51–0.67) 0.70 (0.59–0.84) FG categorical Low 177/808 1.67 (1.34–2.09) 1.48 (1.13–1.94) Medium 207/1441 1 1 High 103/1028 0.66 (0.52–0.85) 0.93 (0.70–1.24) Aspirations Don’t know 199/1328 1.04 (0.84–1.29) 1.07 (0.82–1.38) High school only 84/539 1.09 (0.83–1.44) 1.14 (0.82–1.59) University 198/1370 1 1 Expectations Don’t know 250/1536 1.32 (1.05–1.65) 1.22 (0.93–1.59) High school only 93/638 1.16 (0.87–1.54) 1.00 (0.71–1.40) University 136/1058 1 1 Externalizing problems score ≥11 FG subscale 0.40 (0.34–0.47) 0.58 (0.48–0.71) FG categorical Low 139/806 2.95 (2.24–3.89) 1.93 (1.39–2.69) Medium 95/1440 1 1 High 41/1028 0.59 (0.40–0.86) 0.65 (0.43–0.99) Aspirations Don’t know 119/1328 1.47 (1.10–1.96) 1.32 (0.93–1.86) High school only 63/538 1.98 (1.41–2.79) 1.34 (0.88–2.05) University 86/1369 1 1 Expectations Don’t know 146/1535 1.78 (1.30–2.43) 1.42 (0.98–2.04) High school only 60/638 1.76 (1.21–2.55) 1.10 (0.71–1.71) University 59/1057 1 1 SDQ total difficulties ≥18 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.41 (0.35–0.48) 0.59 (0.49–0.71) FG categorical Low 161/806 2.30 (1.80–2.94) 1.54 (1.15–2.07) Medium 141/1439 1 1 High 55/1028 0.52 (0.38–0.72) 0.68 (0.48–0.97) Aspirations Don’t know 159/1327 1.44 (1.12–1.86) 1.40 (1.03–1.89) High school only 74/538 1.69 (1.24–2.30) 1.33 (0.91–1.94) University 118/1369 1 1 Expectations Don’t know 188/1534 1.68 (1.28–2.21) 1.32 (0.96–1.82) High school only 80/638 1.73 (1.25–2.39) 1.16 (0.79–1.70) University 81/1057 1 1 Internalizing problems score ≥9 FG subscale 0.58 (0.51–0.67) 0.70 (0.59–0.84) FG categorical Low 177/808 1.67 (1.34–2.09) 1.48 (1.13–1.94) Medium 207/1441 1 1 High 103/1028 0.66 (0.52–0.85) 0.93 (0.70–1.24) Aspirations Don’t know 199/1328 1.04 (0.84–1.29) 1.07 (0.82–1.38) High school only 84/539 1.09 (0.83–1.44) 1.14 (0.82–1.59) University 198/1370 1 1 Expectations Don’t know 250/1536 1.32 (1.05–1.65) 1.22 (0.93–1.59) High school only 93/638 1.16 (0.87–1.54) 1.00 (0.71–1.40) University 136/1058 1 1 Externalizing problems score ≥11 FG subscale 0.40 (0.34–0.47) 0.58 (0.48–0.71) FG categorical Low 139/806 2.95 (2.24–3.89) 1.93 (1.39–2.69) Medium 95/1440 1 1 High 41/1028 0.59 (0.40–0.86) 0.65 (0.43–0.99) Aspirations Don’t know 119/1328 1.47 (1.10–1.96) 1.32 (0.93–1.86) High school only 63/538 1.98 (1.41–2.79) 1.34 (0.88–2.05) University 86/1369 1 1 Expectations Don’t know 146/1535 1.78 (1.30–2.43) 1.42 (0.98–2.04) High school only 60/638 1.76 (1.21–2.55) 1.10 (0.71–1.71) University 59/1057 1 1 OR, odds ratio; CI, confidence interval; SDQ, Strengths and Difficulties questionnaire; FG, Future Aspirations and Goals subscale. a Model 1 is unadjusted. b Model 2 is adjusted for baseline mental health, sex of the child, living arrangement, parental education, parental employment, and parents’ birth country. The questions addressing aspirations and expectations as separate constructs were consistent with the FG subscale, but showed weaker associations, and were both similarly related to the mental health measures (tables 2 and 3). We did not find evidence of effect modification by sex or by baseline mental health (data not shown). Discussion In this short-term longitudinal analysis of a large population-based sample, adolescents with high academic aspirations were less likely to develop mental health problems at 1-year follow-up, while the reverse was true for those with low aspirations. This pattern tended to be consistent for measures of both academic aspirations and expectations, and was similar across genders and levels of mental health status at baseline. To our knowledge, this is the first study to investigate the relationship between academic aspirations and mental health in a European context. Our findings corroborate those of earlier studies suggesting that unattained expectations were not associated with an increased risk of depression later in life among American adolescents,18 or of studies reporting positive associations of school engagement31–33 and intrinsic motivation34 with life satisfaction33 and positive mental health outcomes: these latter suggest that high academic aspirations may be part of a wider constellation of positive attitudes towards future life goals. In contrast, several other studies have found that emotional and behavioural problems were higher among those whose aspirations exceeded their expectations.17,35 Similarly, several studies, including some in the Swedish context, have found academic demands and school pressure to be related to negative mental health outcomes.36 It has previously been reported that Swedish adolescents perceive school demands as a large source of stress.37 Furthermore, early adolescence has been found to be a time when academic demands increase but school motivation tends to decrease; the increase in perceived school related pressure between ages 11 and 15 is particularly steep in Sweden.5 The discrepancy between the earlier results concerning the link between school demands and mental ill-health and our own suggests that nurturing high academic aspirations is not necessarily related to academic stress, at least not in our Swedish sample. Perceived pressure and demand from school may be representative of external demand or extrinsic motivation. Individual aspirations, especially when measured by the FG scale which measures not only the desired educational outcomes, but also the value put on school are more related to intrinsic motivation. It may be that developing intrinsic motivation can help young people cope with external academic demand. Sweden has traditionally been charactarized by its strong welfare state. All education, including university, is free of charge. Nearly 90% obtain an upper secondary degree, though this is not compulsary.38 All students are also entitled to a monthly stipend and a low-interest loan while studying at the university level.38 This may thus contribute to minimizing the gap between desired and the projected achievements, an idea supported by the low number of children with a mismatch between aspirations and expectations in our study. Though Sweden continues to have a relatively egalitarian school system compared to countries where tuition fees are required for private schools, changes to school policies since the 1990s have been criticized for creating greater inequalities between schools and between students.39 The last decades have also seen a shift towards the student centred approach to learning, where the responsibility of education has shifted from the schools or teachers to the individual, and teachers are seen as facilitators of learning rather than leaders.40 This may mean that there has been an increase in the importance of students being able to internalize educational goals independently. Those who have adapted to this approach, possibly due to better resources and support such as higher socio-economic status and parental support, are likely to fare better, not only academically, but also in regard to mental health. Although the possibility of a detrimental effect of high academic aspirations on mental health was not supported in our data, it is possible that this was due to the short follow-up or to the young age of the individuals. If there is a link between high aspirations and mental distress, it may require a longer time for these outcomes to manifest. At age 16 in Sweden students must decide their next steps in life, but at age 13 these decisions may seem far away, and concepts of concrete future planning are still somewhat abstract. Strengths of this study include the large sample size, and the prospective–cohort design. The employment of several measures of future academic representations and of mental health was also a strength, allowing an exploration of the consistency of patterns of associations. The study also had some limitations. The study sample resulted from a strong selection, with an under-representation of parents born outside Sweden and of low-educated parents.19 Therefore, the academic aspirations and the mental health profile of this adolescent population may not reflect those of the general population. The internal validity of the results, however, would not be affected by this selection, unless the direction of the association between children’s academic aspirations and mental health would differ according to socio-economic group. Residual confounding (for instance, due to mental health problems occurring earlier in life or among parents) could not be ruled out. Furthermore, the nature of this association is very complex and we had limited possibilities to disentangle psychosocial, social and educational mechanisms involved in these associations because we lacked measures of several potentially relevant factors such as self-esteem, academic grades, cognitive function and general optimism. We conclude that high academic aspirations among young adolescents are associated with a decreased likelihood of developing mental health problems. On the other hand, the finding that low aspirations predicted the onset of mental health problems deserves attention for school-based prevention of mental distress among adolescents. Future studies are needed to investigate whether interventions aimed at increasing aspirations and expectations and engagement in school may positively affect mental health. Acknowledgements We would like to thank the participating schools, students and families, and the administrative KUPOL staff, who make our research possible. Funding The KUPOL study is financially supported by a research grant [nr 259-2012-48] which includes resources from the Swedish Research Council Formas, The Swedish Research Council for Health, Working Life and Welfare, and The Swedish Research Council. Conflicts of interest: None declared. Key points This study investigated the relationship between own academic aspirations and expectations and different measures of mental health among 3343 Swedish adolescents over a 1-year period. To our knowledge, no studies in a European context have investigated the link between academic aspirations and mental health. High academic aspirations were associated with a decreased likelihood of developing both internalizing and externalizing mental health problems, even when considering baseline mental health, socio-demographic and family factors. Both aspirations and expectations were similarly related to the measures of mental health. The results indicate that nurturing high aspirations for individual achievement may be beneficial for young peoples’ mental health. Future research should focus on interventions aimed at increasing academic engagement and aspirations. References 1 Gore FM , Bloem PJ , Patton GC , et al. 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Organisation for Economic Cooperation and Development 2015. Available at: http://www.oecd.org/edu/school/Improving-Schools-in-Sweden.pdf (17 January 2017, date last accessed). 39 Berhanu G . Even in Sweden? Excluding the included: some reflections on the consequences of the new policies on educational processes and outcomes, and equity in education . Int J Spec Ed 2010 ; 25 : 148 – 59 . 40 Kornhall P . Barnexperimentet: Svensk Skola i Fritt Fall (Child Experiment: Swedish School in Freefall) . Leopardförlag , 2013 . © The Author(s) 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The European Journal of Public Health Oxford University Press

Association between adolescents’ academic aspirations and expectations and mental health: a one-year follow-up study

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
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1101-1262
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1464-360X
DOI
10.1093/eurpub/cky025
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Abstract

Abstract Background Mental health problems among youth have increased in Sweden in recent decades, as has competition in higher education and the labour market. It is unknown whether the increasing emphasis put on educational achievement might negatively affect adolescents’ mental health. We aimed to investigate the relationship between adolescents’ academic aspirations and expectations and the risk of mental health problems. Methods We studied 3343 Swedish 7th grade adolescents (age 13), who participated in the first two waves of the KUPOL longitudinal study; participants answered a questionnaire encompassing the five-item Future Aspirations and Goals (FG) subscale of the Student Engagement Instrument, two questions about their own academic aspirations and expectations and two mental health instruments: the Center for Epidemiological studies for Children (CES-DC) (α=.90) and the Strengths and Difficulties Questionnaire (SDQ) (α=.78). The association between aspirations and expectations at baseline and mental health at follow-up was analysed using logistic regression models adjusting for baseline mental health, socio-demographic and family factors. Results The FG subscale was inversely and linearly associated with the odds of high CES-DC score [adjusted OR (odds ratio) 0.71, 95% CI (confidence interval): 0.59–0.86], total Strengths and Difficulties Questionnaire score (OR 0.59, 95% CI 0.49–0.71), and its internalizing (OR 0.70, 95% CI 0.59–0.84) and externalizing problems scores (OR 0.58, 95% CI 0.48–0.71). Conclusions Adolescents with high individual academic aspirations have less mental health problems at 1-year follow-up. Future studies should investigate whether interventions aimed at increasing aspirations and engagement in school may prevent mental health problems in adolescence. Introduction Mental health problems are the largest contributor to morbidity among adolescents and young adults globally,1 and have increased among adolescents in many high-income countries during recent decades, especially internalizing problems among girls.2 In Sweden this increase has been particularly steep.3 Early adolescence (age 10–14) is a phase of life marked not only by an increase in the rate of mental health problems,4 but also by an increase in perceived school pressure5 paired with a decreased interest in school.6 It is an important time when young people develop decision making skills and begin making plans about their futures.7 During the last decades Sweden has faced several controversial changes to the academic system with lasting effects today. The most important policy changes concern the shift of the responsibility for the school system from the state to the municipal level, and the introduction and spread of state funded but privately run ‘free schools’, and an increase in students’ responsibility for their own education.8 These changes are thought to have increased competition both between schools and students.9 Acceptance into higher education and the labour market have both become more competitive in Sweden.10 An increasing number of jobs require a university degree,11 and educational achievement is considered the most important means for young people to improve their opportunities for labour market participation and life circumstances.12 The increasing importance of education for future prospects may influence aspirations regarding academic achievement starting at a young age. Both high and low academic aspirations may have an impact on young people’s mental health through different conceivable pathways. High aspirations nurture strong engagement with school in some cases, which is associated with psychological processes that promote autonomy and positive functioning,13 and ultimately has a positive impact on mental health. Furthermore, low aspirations may be related to academic futility and disengagement in school, which may influence mental health negatively. On the other hand, high aspirations have been found to be associated with stress,14 maladaptive perfectionism15 and even depression and suicide ideation.16 Reverse causation is also possible (i.e. poor mental health may influence an individual’s aspirations). Alternatively, the relationship may be bi-directional in that aspirations and poor mental health reinforce each other over time. Academic aspirations refer to how far a person would like to go in their education, while expectations refer to how far a person believes he/she will go in education.17 While the concepts are similar, and sometimes used interchangeably, some authors have suggested that they are representative of slightly different processes and may not always be aligned.17 The majority of literature on the topic of academic aspirations or expectations focuses on achievement rather than mental health outcomes. One US study found that unmet educational expectations did not predict depression later in life.18 However, this study was initiated in the 1970s and as mentioned previously, trends in mental health and higher education have changed since. To the best of our knowledge, no longitudinal studies in Europe have explored the relationship between students’ own academic aspirations and mental health problems. We investigated whether adolescents’ own academic aspirations are associated with different dimensions of poor mental health, and whether aspirations and expectations relate differently to mental health, in a large longitudinal study of Swedish adolescents. Methods Study population This study is based on the KUPOL cohort study, a complete description of which has previously been published,19 and will be summarized here. Five hundred and forty-one schools were contacted in 2013 from 8 regions of central Sweden. Of these, 101 (62 public and 39 private) participated in the study. Students in 7th grade (age 13) were considered eligible except those with severe learning disabilities or poor comprehension of the Swedish language. Baseline data were collected at two time-points, i.e. in the 2013–14 and the 2014–15 academic years, resulting in two subsequent cohorts of 7th grade students. Follow-up data were collected in the following academic year for each sub-cohort. In total 3343 students answered both baseline and follow-up questionnaires, making this the analytical sample for this study. Compared to the corresponding Swedish average, schools in our sample were more likely to be private schools, to have lower rates of teachers with a university degree and to have lower rates of students whose parents were born outside the country.19 The KUPOL study was approved by the Stockholm Ethics Review Board (reference numbers: 2012/1904-31/1 and 2016/1280-32). Measures Data were collected through questionnaires given to the students and their parents or guardians at baseline and at one year follow-up. Predictors Future aspirations and goals were measured at baseline using the ‘Future aspirations and Goals’ (FG) five-item subscale of the Student Engagement Instrument (SEI).13,20 The SEI measures aspects of cognitive and psychological engagement in school and has shown satisfactory internal validity in multiple contexts.13,20 The five items of the FG subscale measure aspirations and perceived importance for continued education, the value put on education and hopefulness about the future. Response alternatives are scored on a 5-point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’, and the total score is calculated as the mean of the five questions.21 High internal consistency, and correlation with academic outcomes in the expected directions, has previously been found for the FG subscale:15 its Cronbach alpha in our study was .79. In addition to using the FG subscale as a continuous measure, we categorized the upper and lower quartiles of the FG score to investigate the separate effects of very high and very low scores. Students also answered two questions about specific academic expectations and aspirations at baseline which were adapted from the Positive Youth Development 4-H study.22 These two questions ask how far in their education participants would (1) like to and (2) believe they will go, respectively. Response alternatives were ‘I don’t know’, ‘vocational high school’, ‘high school theoretical track’ and ‘university’. We combined the high school tracks into one category. High school (upper secondary school after the age of 16) is not mandatory in Sweden; therefore, students can choose whether or not they want to continue their education after compulsory school, and if so, which track they would like to focus on. The number of participants with a mismatch between aspirations and expectations was too limited to allow investigation of the discrepancies between these two measures; therefore, these specific expectations and aspirations questions were analysed separately in order to investigate whether they related to mental health differently. Outcomes Mental health was measured at baseline and at 1-year follow-up with the Swedish versions of the Centre for Epidemiological Studies Depression scale for Children (CES-DC) and the Strengths and Difficulties Questionnaire (SDQ). Both scales have been extensively validated in Sweden23,24 and internationally.25,26 The CES-DC is a 20-item scale suitable for screening for depressive disorder in young people aged 6–17.23 Each question refers to how often the child experienced a certain symptom in the past week. The four possible response alternatives range from ‘not at all’ to ‘a lot’. The recommended cut-off point of the CES-DC for screening for depressive disorder among adolescents of a score of at least 30 out of 60 points was used to create a binary outcome.23 The scale’s Cronbach alpha was .90. The SDQ is a 25-item scale useful in screening for conduct disorder, hyperactivity, depression and anxiety disorders.26 The scale consists of five subscales representing different areas of psychological strengths and difficulties, labelled as: emotional problems, conduct problems, hyperactivity, peer problems and pro-social behaviour. However, it is recommended in studies of community samples to combine emotional problems and peer problems to derive an internalizing problems subscale, and conduct problems and hyperactivity to derive an externalizing problems subscale.27 Together, the internalizing and externalizing subscales make up the total difficulties scale. The response alternatives are ‘not true’, ‘somewhat true’ and ‘certainly true’. We categorized these scales according to their recommended cut-off points indicating a high or very high score:27,28 these cut-offs are 18 out of 40 for the total difficulties scale,27 9 out of 20 for the internalizing and 11 out of 20 for the externalizing problems subscales.26 The Cronbach’s alphas for the SDQ scales were .78 for the total difficulties scale, .71 for the internalizing problems scale and .73 for the externalizing problems scale. Covariates Information on the child’s living arrangements were obtained from the child’s baseline questionnaire and classified as ‘living’ vs. ‘not living with both parents’, Parents’ birth country [categorized as ‘at least one parent born in Sweden’ (yes/no)], employment [‘both parents employed’ (yes/no)] and education [‘at least one parent with university education’ (yes/no)] were obtained from the parents’ reports at baseline. For the baseline SDQ scales, we used the recommended four-band categorization, and applied the same distribution to derive categories for the CES-DC.27 Statistical analysis We first explored the cluster effect of schools through multi-level modelling with random intercept. The model test statistic (−2 log likelihood) was virtually identical to that obtained through ordinary regression, indicating a negligible effect of student clustering within schools. Therefore, we carried out the analysis ignoring the clustering of the observations. We analysed the distribution of the baseline covariates according to SDQ total difficulties and CES-DC scores at 1-year follow-up using Chi-square tests. As the mental health variables were not normally distributed and we could not normalize them, we investigated the associations between different measures of academic expectations and aspirations and mental health problems using logistic regression. Since we hypothesized that both very high and very low aspirations could increase the risk of mental health problems, we first investigated the association between the categorical FG variable and the four measures of mental ill-health. Tests of linearity suggested a linear relationship between the FG subscale and the measures of mental health, thus, in all further analyses we included the FG scale as both a continuous and categorical variable. We fitted models for measures of baseline academic aspirations and expectations and each measure of mental health at follow up, both unadjusted (model 1), and adjusted for baseline mental health, sex of the child, child’s living arrangement, parents’ employment, parents’ education and parents’ country of birth (model 2). The reason for considering these factors as confounders is that they may be associated with both aspirations and expectations and have been shown to be associated with poor mental health,29 but they are not in the causal pathway between exposure and outcome. We hypothesized that poor mental health at baseline, sex (because there are indicators that girls may have higher academic aspirations than boys30) low parental socioeconomic status (measured by education and employment) having immigrant parents (which could render some difficulties in navigating the Swedish school system) may hamper development of high academic aspirations. Approximately 11% of study participants in the analytical sample had missing information on at least one of the covariates. As a sensitivity analysis, we built logistic regression models to compare differences in results from multiple imputed datasets and after pairwise deletion. This analysis indicated that associations and standard errors differed only marginally between these two approaches; therefore, results are presented without imputation. Effect modification by gender and baseline mental health was investigated using stratified analysis and by formal tests of interaction. Analyses were conducted using SAS Enterprise Guide 7.1. Results Participants with high scores on the CES-DC and SDQ total difficulties scales at follow-up were more likely to be girls, not living with both of their parents, having parents with only basic or secondary education, at least one unemployed parent and a higher CES-DC or SDQ score at baseline compared to those with scores within the normal range (table 1). Table 1 Characteristics of the study population at baseline according to CES-DC and SDQ scores at follow up N (%) CES-DC SDQ ≥30 (N = 401) <30 (N = 2911) Pa ≥18 (N = 362) <18 (N = 2955) Pa N (%) N (%) N (%) N (%) Sex Boys 1599 (47.83) 61 (15.21) 1524 (52.35) 121 (33.43) 1462 (49.48) Girls 1744 (52.17) 340 (84.79) 1387 (47.65) <.001 241 (66.57) 1493 (50.52) <.001 Living arrangement Lives with both parents 3125 (93.56) 361 (90.02) 2736 (94.09) 318 (87.85) 2784 (94.31) Lives with only one or neither parent 215 (6.44) 40 (9.98) 172 (5.91) .002 44 (12.15) 168 (5.69) <.001 Missing 3 Parents’ education One or both went to university 2234 (69.10) 251 (64.19) 1964 (69.82) 194 (54.96) 2021 (70.81) Neither went to university 999 (30.90) 140 (35.81) 849 (30.18) .024 159 (45.04) 833 (29.19) <.001 Missing 110 Parents’ employment Both employed 2722 (85.52) 313 (81.72) 2387 (86.05) 276 (80.23) 2425 (86.18) One or both unemployed 461 (14.48) 70 (18.28) 387 (13.95) .017 68 (19.77) 389 (13.82) .003 Missing 160 Parents’ birth country At least one parent born in Sweden 2970 (91.84) 360 (93.02) 2585 (91.73) 320 (91.69) 2629 (91.96) Neither parent born in Sweden 264 (8.16) 27 (6.98) 233 (8.27) .383 29 (8.31) 230 (8.04) .864 Missing 109 Baseline CES-DC Average 2642 (80.21) 147 (37.22) 2475 (86.24) 161 (45.10) 2462 (84.55) Raised 351 (10.66) 96 (24.30) 248 (8.64) 71 (19.89) 276 (9.48) High 146 (4.43) 59 (14.94) 86 (3.00) 52 (14.57) 93 (3.19) Very high 155 (4.71) 93 (23.54) 61 (2.13) <.001 73 (20.45) 81 (2.78) <.001 Missing 49 Baseline SDQ Average 2728 (82.52) 204 (51.78) 2496 (86.64) 141 (39.50) 2563 (87.68) Raised 308 (9.32) 78 (19.80) 228 (7.91) 77 (21.57) 230 (7.87) High 109 (3.30) 39 (9.90) 69 (2.40) 44 (12.32) 65 (2.22) Very high 161 (4.87) 73 (18.53) 88 (3.05) <.001 95 (26.61) 65 (2.22) <.001 Missing 37 N (%) CES-DC SDQ ≥30 (N = 401) <30 (N = 2911) Pa ≥18 (N = 362) <18 (N = 2955) Pa N (%) N (%) N (%) N (%) Sex Boys 1599 (47.83) 61 (15.21) 1524 (52.35) 121 (33.43) 1462 (49.48) Girls 1744 (52.17) 340 (84.79) 1387 (47.65) <.001 241 (66.57) 1493 (50.52) <.001 Living arrangement Lives with both parents 3125 (93.56) 361 (90.02) 2736 (94.09) 318 (87.85) 2784 (94.31) Lives with only one or neither parent 215 (6.44) 40 (9.98) 172 (5.91) .002 44 (12.15) 168 (5.69) <.001 Missing 3 Parents’ education One or both went to university 2234 (69.10) 251 (64.19) 1964 (69.82) 194 (54.96) 2021 (70.81) Neither went to university 999 (30.90) 140 (35.81) 849 (30.18) .024 159 (45.04) 833 (29.19) <.001 Missing 110 Parents’ employment Both employed 2722 (85.52) 313 (81.72) 2387 (86.05) 276 (80.23) 2425 (86.18) One or both unemployed 461 (14.48) 70 (18.28) 387 (13.95) .017 68 (19.77) 389 (13.82) .003 Missing 160 Parents’ birth country At least one parent born in Sweden 2970 (91.84) 360 (93.02) 2585 (91.73) 320 (91.69) 2629 (91.96) Neither parent born in Sweden 264 (8.16) 27 (6.98) 233 (8.27) .383 29 (8.31) 230 (8.04) .864 Missing 109 Baseline CES-DC Average 2642 (80.21) 147 (37.22) 2475 (86.24) 161 (45.10) 2462 (84.55) Raised 351 (10.66) 96 (24.30) 248 (8.64) 71 (19.89) 276 (9.48) High 146 (4.43) 59 (14.94) 86 (3.00) 52 (14.57) 93 (3.19) Very high 155 (4.71) 93 (23.54) 61 (2.13) <.001 73 (20.45) 81 (2.78) <.001 Missing 49 Baseline SDQ Average 2728 (82.52) 204 (51.78) 2496 (86.64) 141 (39.50) 2563 (87.68) Raised 308 (9.32) 78 (19.80) 228 (7.91) 77 (21.57) 230 (7.87) High 109 (3.30) 39 (9.90) 69 (2.40) 44 (12.32) 65 (2.22) Very high 161 (4.87) 73 (18.53) 88 (3.05) <.001 95 (26.61) 65 (2.22) <.001 Missing 37 SDQ, Strengths and Difficulties Questionnaire; CES-DC, Centre for Epidemiological Studies Depression scale for Children. a P-values correspond to Chi-square test comparing the distribution of the independent variables according to the SDQ and CES-DC categories. Table 1 Characteristics of the study population at baseline according to CES-DC and SDQ scores at follow up N (%) CES-DC SDQ ≥30 (N = 401) <30 (N = 2911) Pa ≥18 (N = 362) <18 (N = 2955) Pa N (%) N (%) N (%) N (%) Sex Boys 1599 (47.83) 61 (15.21) 1524 (52.35) 121 (33.43) 1462 (49.48) Girls 1744 (52.17) 340 (84.79) 1387 (47.65) <.001 241 (66.57) 1493 (50.52) <.001 Living arrangement Lives with both parents 3125 (93.56) 361 (90.02) 2736 (94.09) 318 (87.85) 2784 (94.31) Lives with only one or neither parent 215 (6.44) 40 (9.98) 172 (5.91) .002 44 (12.15) 168 (5.69) <.001 Missing 3 Parents’ education One or both went to university 2234 (69.10) 251 (64.19) 1964 (69.82) 194 (54.96) 2021 (70.81) Neither went to university 999 (30.90) 140 (35.81) 849 (30.18) .024 159 (45.04) 833 (29.19) <.001 Missing 110 Parents’ employment Both employed 2722 (85.52) 313 (81.72) 2387 (86.05) 276 (80.23) 2425 (86.18) One or both unemployed 461 (14.48) 70 (18.28) 387 (13.95) .017 68 (19.77) 389 (13.82) .003 Missing 160 Parents’ birth country At least one parent born in Sweden 2970 (91.84) 360 (93.02) 2585 (91.73) 320 (91.69) 2629 (91.96) Neither parent born in Sweden 264 (8.16) 27 (6.98) 233 (8.27) .383 29 (8.31) 230 (8.04) .864 Missing 109 Baseline CES-DC Average 2642 (80.21) 147 (37.22) 2475 (86.24) 161 (45.10) 2462 (84.55) Raised 351 (10.66) 96 (24.30) 248 (8.64) 71 (19.89) 276 (9.48) High 146 (4.43) 59 (14.94) 86 (3.00) 52 (14.57) 93 (3.19) Very high 155 (4.71) 93 (23.54) 61 (2.13) <.001 73 (20.45) 81 (2.78) <.001 Missing 49 Baseline SDQ Average 2728 (82.52) 204 (51.78) 2496 (86.64) 141 (39.50) 2563 (87.68) Raised 308 (9.32) 78 (19.80) 228 (7.91) 77 (21.57) 230 (7.87) High 109 (3.30) 39 (9.90) 69 (2.40) 44 (12.32) 65 (2.22) Very high 161 (4.87) 73 (18.53) 88 (3.05) <.001 95 (26.61) 65 (2.22) <.001 Missing 37 N (%) CES-DC SDQ ≥30 (N = 401) <30 (N = 2911) Pa ≥18 (N = 362) <18 (N = 2955) Pa N (%) N (%) N (%) N (%) Sex Boys 1599 (47.83) 61 (15.21) 1524 (52.35) 121 (33.43) 1462 (49.48) Girls 1744 (52.17) 340 (84.79) 1387 (47.65) <.001 241 (66.57) 1493 (50.52) <.001 Living arrangement Lives with both parents 3125 (93.56) 361 (90.02) 2736 (94.09) 318 (87.85) 2784 (94.31) Lives with only one or neither parent 215 (6.44) 40 (9.98) 172 (5.91) .002 44 (12.15) 168 (5.69) <.001 Missing 3 Parents’ education One or both went to university 2234 (69.10) 251 (64.19) 1964 (69.82) 194 (54.96) 2021 (70.81) Neither went to university 999 (30.90) 140 (35.81) 849 (30.18) .024 159 (45.04) 833 (29.19) <.001 Missing 110 Parents’ employment Both employed 2722 (85.52) 313 (81.72) 2387 (86.05) 276 (80.23) 2425 (86.18) One or both unemployed 461 (14.48) 70 (18.28) 387 (13.95) .017 68 (19.77) 389 (13.82) .003 Missing 160 Parents’ birth country At least one parent born in Sweden 2970 (91.84) 360 (93.02) 2585 (91.73) 320 (91.69) 2629 (91.96) Neither parent born in Sweden 264 (8.16) 27 (6.98) 233 (8.27) .383 29 (8.31) 230 (8.04) .864 Missing 109 Baseline CES-DC Average 2642 (80.21) 147 (37.22) 2475 (86.24) 161 (45.10) 2462 (84.55) Raised 351 (10.66) 96 (24.30) 248 (8.64) 71 (19.89) 276 (9.48) High 146 (4.43) 59 (14.94) 86 (3.00) 52 (14.57) 93 (3.19) Very high 155 (4.71) 93 (23.54) 61 (2.13) <.001 73 (20.45) 81 (2.78) <.001 Missing 49 Baseline SDQ Average 2728 (82.52) 204 (51.78) 2496 (86.64) 141 (39.50) 2563 (87.68) Raised 308 (9.32) 78 (19.80) 228 (7.91) 77 (21.57) 230 (7.87) High 109 (3.30) 39 (9.90) 69 (2.40) 44 (12.32) 65 (2.22) Very high 161 (4.87) 73 (18.53) 88 (3.05) <.001 95 (26.61) 65 (2.22) <.001 Missing 37 SDQ, Strengths and Difficulties Questionnaire; CES-DC, Centre for Epidemiological Studies Depression scale for Children. a P-values correspond to Chi-square test comparing the distribution of the independent variables according to the SDQ and CES-DC categories. In multivariate models, the continuous FG scale was linearly and inversely associated with the odds of high CES-DC [odds ratio (OR) 0.71, 95% confidence intervals (CI) 0.59–0.86], SDQ total difficulties (OR 0.59, 95% CI 0.49–0.71), SDQ internalizing (OR 0.79, 95% CI 0.59–0.84) and SDQ externalizing (OR 0.58 95% CI 0.48–0.71) scores. Results tended to be similar when the categorical FG scale was used, albeit precision was lower (tables 2 and 3). Table 2 Odds ratios and 95% confidence intervals for depressive symptoms at follow-up, according to measures of baseline academic aspirations or expectations CES-DC score ≥30 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.54 (0.47–0.62) 0.71 (0.59–0.86) FG categorical Low 158/809 1.85 (1.46–2.34) 1.49 (1.12–2.00) Medium 167/1437 1 1 High 72/1022 0.58 (0.43–0.77) 0.73 (0.52–1.00) Aspirations Don’t know 157/1328 1.07 (0.84–1.35) 1.16 (0.87–1.54) High school only 83/539 1.45 (1.09–1.93) 1.53 (1.07–2.17) University 152/1362 1 1 Expectations Don’t know 200/1535 1.43 (1.11–1.84) 1.33 (0.99–1.79) High school only 88/636 1.53 (1.13–2.08) 1.32 (0.92–1.90) University 100/1054 1 1 CES-DC score ≥30 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.54 (0.47–0.62) 0.71 (0.59–0.86) FG categorical Low 158/809 1.85 (1.46–2.34) 1.49 (1.12–2.00) Medium 167/1437 1 1 High 72/1022 0.58 (0.43–0.77) 0.73 (0.52–1.00) Aspirations Don’t know 157/1328 1.07 (0.84–1.35) 1.16 (0.87–1.54) High school only 83/539 1.45 (1.09–1.93) 1.53 (1.07–2.17) University 152/1362 1 1 Expectations Don’t know 200/1535 1.43 (1.11–1.84) 1.33 (0.99–1.79) High school only 88/636 1.53 (1.13–2.08) 1.32 (0.92–1.90) University 100/1054 1 1 OR, odds ratio; CI, confidence interval; CES–DC, Centre for Epidemiological Studies Depression Scale for Children; FG, Future Aspirations and Goals subscale. a Model 1 is unadjusted. b Model 2 is adjusted for baseline mental health, sex of the child, living arrangement, parental education, parental employment, and parents’ birth country. Table 2 Odds ratios and 95% confidence intervals for depressive symptoms at follow-up, according to measures of baseline academic aspirations or expectations CES-DC score ≥30 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.54 (0.47–0.62) 0.71 (0.59–0.86) FG categorical Low 158/809 1.85 (1.46–2.34) 1.49 (1.12–2.00) Medium 167/1437 1 1 High 72/1022 0.58 (0.43–0.77) 0.73 (0.52–1.00) Aspirations Don’t know 157/1328 1.07 (0.84–1.35) 1.16 (0.87–1.54) High school only 83/539 1.45 (1.09–1.93) 1.53 (1.07–2.17) University 152/1362 1 1 Expectations Don’t know 200/1535 1.43 (1.11–1.84) 1.33 (0.99–1.79) High school only 88/636 1.53 (1.13–2.08) 1.32 (0.92–1.90) University 100/1054 1 1 CES-DC score ≥30 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.54 (0.47–0.62) 0.71 (0.59–0.86) FG categorical Low 158/809 1.85 (1.46–2.34) 1.49 (1.12–2.00) Medium 167/1437 1 1 High 72/1022 0.58 (0.43–0.77) 0.73 (0.52–1.00) Aspirations Don’t know 157/1328 1.07 (0.84–1.35) 1.16 (0.87–1.54) High school only 83/539 1.45 (1.09–1.93) 1.53 (1.07–2.17) University 152/1362 1 1 Expectations Don’t know 200/1535 1.43 (1.11–1.84) 1.33 (0.99–1.79) High school only 88/636 1.53 (1.13–2.08) 1.32 (0.92–1.90) University 100/1054 1 1 OR, odds ratio; CI, confidence interval; CES–DC, Centre for Epidemiological Studies Depression Scale for Children; FG, Future Aspirations and Goals subscale. a Model 1 is unadjusted. b Model 2 is adjusted for baseline mental health, sex of the child, living arrangement, parental education, parental employment, and parents’ birth country. Table 3 Odds ratios and 95% confidence intervals for mental health problems at follow-up measured by the Strength and Difficulties Questionnaire according to measures of baseline academic aspirations or expectations SDQ total difficulties ≥18 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.41 (0.35–0.48) 0.59 (0.49–0.71) FG categorical Low 161/806 2.30 (1.80–2.94) 1.54 (1.15–2.07) Medium 141/1439 1 1 High 55/1028 0.52 (0.38–0.72) 0.68 (0.48–0.97) Aspirations Don’t know 159/1327 1.44 (1.12–1.86) 1.40 (1.03–1.89) High school only 74/538 1.69 (1.24–2.30) 1.33 (0.91–1.94) University 118/1369 1 1 Expectations Don’t know 188/1534 1.68 (1.28–2.21) 1.32 (0.96–1.82) High school only 80/638 1.73 (1.25–2.39) 1.16 (0.79–1.70) University 81/1057 1 1 Internalizing problems score ≥9 FG subscale 0.58 (0.51–0.67) 0.70 (0.59–0.84) FG categorical Low 177/808 1.67 (1.34–2.09) 1.48 (1.13–1.94) Medium 207/1441 1 1 High 103/1028 0.66 (0.52–0.85) 0.93 (0.70–1.24) Aspirations Don’t know 199/1328 1.04 (0.84–1.29) 1.07 (0.82–1.38) High school only 84/539 1.09 (0.83–1.44) 1.14 (0.82–1.59) University 198/1370 1 1 Expectations Don’t know 250/1536 1.32 (1.05–1.65) 1.22 (0.93–1.59) High school only 93/638 1.16 (0.87–1.54) 1.00 (0.71–1.40) University 136/1058 1 1 Externalizing problems score ≥11 FG subscale 0.40 (0.34–0.47) 0.58 (0.48–0.71) FG categorical Low 139/806 2.95 (2.24–3.89) 1.93 (1.39–2.69) Medium 95/1440 1 1 High 41/1028 0.59 (0.40–0.86) 0.65 (0.43–0.99) Aspirations Don’t know 119/1328 1.47 (1.10–1.96) 1.32 (0.93–1.86) High school only 63/538 1.98 (1.41–2.79) 1.34 (0.88–2.05) University 86/1369 1 1 Expectations Don’t know 146/1535 1.78 (1.30–2.43) 1.42 (0.98–2.04) High school only 60/638 1.76 (1.21–2.55) 1.10 (0.71–1.71) University 59/1057 1 1 SDQ total difficulties ≥18 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.41 (0.35–0.48) 0.59 (0.49–0.71) FG categorical Low 161/806 2.30 (1.80–2.94) 1.54 (1.15–2.07) Medium 141/1439 1 1 High 55/1028 0.52 (0.38–0.72) 0.68 (0.48–0.97) Aspirations Don’t know 159/1327 1.44 (1.12–1.86) 1.40 (1.03–1.89) High school only 74/538 1.69 (1.24–2.30) 1.33 (0.91–1.94) University 118/1369 1 1 Expectations Don’t know 188/1534 1.68 (1.28–2.21) 1.32 (0.96–1.82) High school only 80/638 1.73 (1.25–2.39) 1.16 (0.79–1.70) University 81/1057 1 1 Internalizing problems score ≥9 FG subscale 0.58 (0.51–0.67) 0.70 (0.59–0.84) FG categorical Low 177/808 1.67 (1.34–2.09) 1.48 (1.13–1.94) Medium 207/1441 1 1 High 103/1028 0.66 (0.52–0.85) 0.93 (0.70–1.24) Aspirations Don’t know 199/1328 1.04 (0.84–1.29) 1.07 (0.82–1.38) High school only 84/539 1.09 (0.83–1.44) 1.14 (0.82–1.59) University 198/1370 1 1 Expectations Don’t know 250/1536 1.32 (1.05–1.65) 1.22 (0.93–1.59) High school only 93/638 1.16 (0.87–1.54) 1.00 (0.71–1.40) University 136/1058 1 1 Externalizing problems score ≥11 FG subscale 0.40 (0.34–0.47) 0.58 (0.48–0.71) FG categorical Low 139/806 2.95 (2.24–3.89) 1.93 (1.39–2.69) Medium 95/1440 1 1 High 41/1028 0.59 (0.40–0.86) 0.65 (0.43–0.99) Aspirations Don’t know 119/1328 1.47 (1.10–1.96) 1.32 (0.93–1.86) High school only 63/538 1.98 (1.41–2.79) 1.34 (0.88–2.05) University 86/1369 1 1 Expectations Don’t know 146/1535 1.78 (1.30–2.43) 1.42 (0.98–2.04) High school only 60/638 1.76 (1.21–2.55) 1.10 (0.71–1.71) University 59/1057 1 1 OR, odds ratio; CI, confidence interval; SDQ, Strengths and Difficulties questionnaire; FG, Future Aspirations and Goals subscale. a Model 1 is unadjusted. b Model 2 is adjusted for baseline mental health, sex of the child, living arrangement, parental education, parental employment, and parents’ birth country. Table 3 Odds ratios and 95% confidence intervals for mental health problems at follow-up measured by the Strength and Difficulties Questionnaire according to measures of baseline academic aspirations or expectations SDQ total difficulties ≥18 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.41 (0.35–0.48) 0.59 (0.49–0.71) FG categorical Low 161/806 2.30 (1.80–2.94) 1.54 (1.15–2.07) Medium 141/1439 1 1 High 55/1028 0.52 (0.38–0.72) 0.68 (0.48–0.97) Aspirations Don’t know 159/1327 1.44 (1.12–1.86) 1.40 (1.03–1.89) High school only 74/538 1.69 (1.24–2.30) 1.33 (0.91–1.94) University 118/1369 1 1 Expectations Don’t know 188/1534 1.68 (1.28–2.21) 1.32 (0.96–1.82) High school only 80/638 1.73 (1.25–2.39) 1.16 (0.79–1.70) University 81/1057 1 1 Internalizing problems score ≥9 FG subscale 0.58 (0.51–0.67) 0.70 (0.59–0.84) FG categorical Low 177/808 1.67 (1.34–2.09) 1.48 (1.13–1.94) Medium 207/1441 1 1 High 103/1028 0.66 (0.52–0.85) 0.93 (0.70–1.24) Aspirations Don’t know 199/1328 1.04 (0.84–1.29) 1.07 (0.82–1.38) High school only 84/539 1.09 (0.83–1.44) 1.14 (0.82–1.59) University 198/1370 1 1 Expectations Don’t know 250/1536 1.32 (1.05–1.65) 1.22 (0.93–1.59) High school only 93/638 1.16 (0.87–1.54) 1.00 (0.71–1.40) University 136/1058 1 1 Externalizing problems score ≥11 FG subscale 0.40 (0.34–0.47) 0.58 (0.48–0.71) FG categorical Low 139/806 2.95 (2.24–3.89) 1.93 (1.39–2.69) Medium 95/1440 1 1 High 41/1028 0.59 (0.40–0.86) 0.65 (0.43–0.99) Aspirations Don’t know 119/1328 1.47 (1.10–1.96) 1.32 (0.93–1.86) High school only 63/538 1.98 (1.41–2.79) 1.34 (0.88–2.05) University 86/1369 1 1 Expectations Don’t know 146/1535 1.78 (1.30–2.43) 1.42 (0.98–2.04) High school only 60/638 1.76 (1.21–2.55) 1.10 (0.71–1.71) University 59/1057 1 1 SDQ total difficulties ≥18 Events at follow-up/N OR (95% CI) Model 1a Model 2b FG subscale 0.41 (0.35–0.48) 0.59 (0.49–0.71) FG categorical Low 161/806 2.30 (1.80–2.94) 1.54 (1.15–2.07) Medium 141/1439 1 1 High 55/1028 0.52 (0.38–0.72) 0.68 (0.48–0.97) Aspirations Don’t know 159/1327 1.44 (1.12–1.86) 1.40 (1.03–1.89) High school only 74/538 1.69 (1.24–2.30) 1.33 (0.91–1.94) University 118/1369 1 1 Expectations Don’t know 188/1534 1.68 (1.28–2.21) 1.32 (0.96–1.82) High school only 80/638 1.73 (1.25–2.39) 1.16 (0.79–1.70) University 81/1057 1 1 Internalizing problems score ≥9 FG subscale 0.58 (0.51–0.67) 0.70 (0.59–0.84) FG categorical Low 177/808 1.67 (1.34–2.09) 1.48 (1.13–1.94) Medium 207/1441 1 1 High 103/1028 0.66 (0.52–0.85) 0.93 (0.70–1.24) Aspirations Don’t know 199/1328 1.04 (0.84–1.29) 1.07 (0.82–1.38) High school only 84/539 1.09 (0.83–1.44) 1.14 (0.82–1.59) University 198/1370 1 1 Expectations Don’t know 250/1536 1.32 (1.05–1.65) 1.22 (0.93–1.59) High school only 93/638 1.16 (0.87–1.54) 1.00 (0.71–1.40) University 136/1058 1 1 Externalizing problems score ≥11 FG subscale 0.40 (0.34–0.47) 0.58 (0.48–0.71) FG categorical Low 139/806 2.95 (2.24–3.89) 1.93 (1.39–2.69) Medium 95/1440 1 1 High 41/1028 0.59 (0.40–0.86) 0.65 (0.43–0.99) Aspirations Don’t know 119/1328 1.47 (1.10–1.96) 1.32 (0.93–1.86) High school only 63/538 1.98 (1.41–2.79) 1.34 (0.88–2.05) University 86/1369 1 1 Expectations Don’t know 146/1535 1.78 (1.30–2.43) 1.42 (0.98–2.04) High school only 60/638 1.76 (1.21–2.55) 1.10 (0.71–1.71) University 59/1057 1 1 OR, odds ratio; CI, confidence interval; SDQ, Strengths and Difficulties questionnaire; FG, Future Aspirations and Goals subscale. a Model 1 is unadjusted. b Model 2 is adjusted for baseline mental health, sex of the child, living arrangement, parental education, parental employment, and parents’ birth country. The questions addressing aspirations and expectations as separate constructs were consistent with the FG subscale, but showed weaker associations, and were both similarly related to the mental health measures (tables 2 and 3). We did not find evidence of effect modification by sex or by baseline mental health (data not shown). Discussion In this short-term longitudinal analysis of a large population-based sample, adolescents with high academic aspirations were less likely to develop mental health problems at 1-year follow-up, while the reverse was true for those with low aspirations. This pattern tended to be consistent for measures of both academic aspirations and expectations, and was similar across genders and levels of mental health status at baseline. To our knowledge, this is the first study to investigate the relationship between academic aspirations and mental health in a European context. Our findings corroborate those of earlier studies suggesting that unattained expectations were not associated with an increased risk of depression later in life among American adolescents,18 or of studies reporting positive associations of school engagement31–33 and intrinsic motivation34 with life satisfaction33 and positive mental health outcomes: these latter suggest that high academic aspirations may be part of a wider constellation of positive attitudes towards future life goals. In contrast, several other studies have found that emotional and behavioural problems were higher among those whose aspirations exceeded their expectations.17,35 Similarly, several studies, including some in the Swedish context, have found academic demands and school pressure to be related to negative mental health outcomes.36 It has previously been reported that Swedish adolescents perceive school demands as a large source of stress.37 Furthermore, early adolescence has been found to be a time when academic demands increase but school motivation tends to decrease; the increase in perceived school related pressure between ages 11 and 15 is particularly steep in Sweden.5 The discrepancy between the earlier results concerning the link between school demands and mental ill-health and our own suggests that nurturing high academic aspirations is not necessarily related to academic stress, at least not in our Swedish sample. Perceived pressure and demand from school may be representative of external demand or extrinsic motivation. Individual aspirations, especially when measured by the FG scale which measures not only the desired educational outcomes, but also the value put on school are more related to intrinsic motivation. It may be that developing intrinsic motivation can help young people cope with external academic demand. Sweden has traditionally been charactarized by its strong welfare state. All education, including university, is free of charge. Nearly 90% obtain an upper secondary degree, though this is not compulsary.38 All students are also entitled to a monthly stipend and a low-interest loan while studying at the university level.38 This may thus contribute to minimizing the gap between desired and the projected achievements, an idea supported by the low number of children with a mismatch between aspirations and expectations in our study. Though Sweden continues to have a relatively egalitarian school system compared to countries where tuition fees are required for private schools, changes to school policies since the 1990s have been criticized for creating greater inequalities between schools and between students.39 The last decades have also seen a shift towards the student centred approach to learning, where the responsibility of education has shifted from the schools or teachers to the individual, and teachers are seen as facilitators of learning rather than leaders.40 This may mean that there has been an increase in the importance of students being able to internalize educational goals independently. Those who have adapted to this approach, possibly due to better resources and support such as higher socio-economic status and parental support, are likely to fare better, not only academically, but also in regard to mental health. Although the possibility of a detrimental effect of high academic aspirations on mental health was not supported in our data, it is possible that this was due to the short follow-up or to the young age of the individuals. If there is a link between high aspirations and mental distress, it may require a longer time for these outcomes to manifest. At age 16 in Sweden students must decide their next steps in life, but at age 13 these decisions may seem far away, and concepts of concrete future planning are still somewhat abstract. Strengths of this study include the large sample size, and the prospective–cohort design. The employment of several measures of future academic representations and of mental health was also a strength, allowing an exploration of the consistency of patterns of associations. The study also had some limitations. The study sample resulted from a strong selection, with an under-representation of parents born outside Sweden and of low-educated parents.19 Therefore, the academic aspirations and the mental health profile of this adolescent population may not reflect those of the general population. The internal validity of the results, however, would not be affected by this selection, unless the direction of the association between children’s academic aspirations and mental health would differ according to socio-economic group. Residual confounding (for instance, due to mental health problems occurring earlier in life or among parents) could not be ruled out. Furthermore, the nature of this association is very complex and we had limited possibilities to disentangle psychosocial, social and educational mechanisms involved in these associations because we lacked measures of several potentially relevant factors such as self-esteem, academic grades, cognitive function and general optimism. We conclude that high academic aspirations among young adolescents are associated with a decreased likelihood of developing mental health problems. On the other hand, the finding that low aspirations predicted the onset of mental health problems deserves attention for school-based prevention of mental distress among adolescents. Future studies are needed to investigate whether interventions aimed at increasing aspirations and expectations and engagement in school may positively affect mental health. Acknowledgements We would like to thank the participating schools, students and families, and the administrative KUPOL staff, who make our research possible. Funding The KUPOL study is financially supported by a research grant [nr 259-2012-48] which includes resources from the Swedish Research Council Formas, The Swedish Research Council for Health, Working Life and Welfare, and The Swedish Research Council. Conflicts of interest: None declared. Key points This study investigated the relationship between own academic aspirations and expectations and different measures of mental health among 3343 Swedish adolescents over a 1-year period. To our knowledge, no studies in a European context have investigated the link between academic aspirations and mental health. High academic aspirations were associated with a decreased likelihood of developing both internalizing and externalizing mental health problems, even when considering baseline mental health, socio-demographic and family factors. Both aspirations and expectations were similarly related to the measures of mental health. The results indicate that nurturing high aspirations for individual achievement may be beneficial for young peoples’ mental health. Future research should focus on interventions aimed at increasing academic engagement and aspirations. References 1 Gore FM , Bloem PJ , Patton GC , et al. 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Journal

The European Journal of Public Health – Oxford University Press

Published: Mar 24, 2018

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