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Men al heal h p o iles o Finnish adolescen s be o e and a e he peak o he COVID-19
pandemic
© The Au ho (s) 2023
Published e sion
Gus a sson, Jasmine; Lyy a, Nelli; Jasinskaja-Lah i, Inga; Simonsen, Nina; Lah i,
Hen i; Kulmala, Ma kus; Ojala, K is iina; Paakka i, Leena
Gus a sson, J., Lyy a, N., Jasinskaja-Lah i, I., Simonsen, N., Lah i, H., Kulmala, M., Ojala, K., &
Paakka i, L. (2023). Men al heal h p o iles o Finnish adolescen s be o e and a e he peak o
he COVID-19 pandemic. Child and Adolescen Psychia y and Men al Heal h, 17, A icle 54.
h ps://doi.o g/10.1186/s13034-023-00591-1
2023
Gus a ssone al.
Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
h ps://doi.o g/10.1186/s13034-023-00591-1
RESEARCH Open Access
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Child and Adolescen Psychia y
and Men al Heal h
Men al heal h p o iles o Finnish adolescen s
be o eanda e hepeak o  heCOVID-19
pandemic
Jasmine Gus a sson1,2,3*, Nelli Lyy a1, Inga Jasinskaja‑Lah i2, Nina Simonsen3,4, Hen i Lah i1, Ma kus Kulmala1,
K is iina Ojala1 and Leena Paakka i1
Abs ac
Backg ound The COVID‑19 pandemic has had implica ions o adolescen s’ in e pe sonal ela ionships, communi‑
ca ion pa e ns, educa ion, ec ea ional ac i i ies and well‑being. An unde s anding o he impac o he pandemic
on hei men al heal h is c ucial in measu es o p omo e he pos ‑pandemic eco e y. Using a pe son‑cen e ed
app oach, he cu en s udy aimed o iden i y men al heal h p o iles in wo c oss‑sec ional samples o Finnish adoles‑
cen s be o e and a e he peak o he pandemic, and o examine how socio‑demog aphic and psychosocial ac o s,
academic expec a ions, heal h li e acy, and sel ‑ a ed heal h a e associa ed wi h he eme ging p o iles.
Me hods and indings Su ey da a om he Heal h Beha iou in School‑aged Child en (HBSC) s udy conduc ed
in Finland in 2018 (N = 3498, age M = 13.44) and 2022 (N = 3838, age M = 13.21) we e analyzed. A ou ‑p o ile model
using clus e analysis was selec ed o bo h samples. In Sample 1, he iden i ied p o iles we e (1) “Good men al heal h”,
(2) “Mixed psychosocial heal h”, (3) “Soma ically challenged”, and (4) “Poo men al heal h”. In Sample 2, he iden i ied
p o iles we e (1) “Good men al heal h”, (2) “Mixed psychosoma ic heal h”, (3) “Poo men al heal h and low loneliness”,
and (4) “Poo men al heal h and high loneliness”. The esul s o he mixed e ec mul inomial logis ic eg ession analy‑
sis showed ha in bo h samples, being a gi l and epo ing lowe ma e nal moni o ing; lowe amily, pee , and eache
suppo ; highe in ensi y o online communica ion; a less posi i e home a mosphe e and school clima e; and poo
sel ‑ a ed heal h we e mos s ongly linked o belonging o a poo e men al heal h p o ile. In addi ion, in Sample 2,
low subjec i e heal h li e acy was a key ac o associa ed wi h poo e men al heal h p o iles, and eache suppo was
mo e impo an han be o e COVID.
Conclusions The cu en s udy s esses he impo ance o iden i ying hose ulne able o de eloping poo men al
heal h. To maximize pos ‑pandemic eco e y, he ole o schools, especially eache suppo and heal h li e acy, along
wi h he ac o s ha emained impo an o e ime should be aken in o accoun in public heal h and heal h p omo‑
ion in e en ions.
Keywo ds Men al heal h, Social ela ionships, Adolescence, COVID‑19 pandemic, Clus e analysis
*Co espondence:
Jasmine Gus a sson
jasmine.g.gus a sson@helsinki. i
Full lis o au ho in o ma ion is a ailable a he end o he a icle
Page 2 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
In oduc ion
Resea ch du ing he COVID-19 pandemic has aised
conce ns o e he poo men al heal h o child en and
adolescen s. Acco ding o se e al e iews and me a-anal-
yses, he men al heal h o you hs has de e io a ed du ing
he pandemic [1–4], pa icula ly in e ms o inc eased
anxie y and dep ession symp oms. Fo example, he
me a-analysis by Panda e al. [2] ound ha du ing he
1yea o he pandemic, be ween 31 and 42% o child en
and adolescen s expe ienced men al heal h p oblems
such as anxie y, dep ession, and i i abili y. In addi ion,
a popula ion-based longi udinal s udy in Ge many [5]
ound ha adolescen s’ psychosoma ic complain s we e
mo e p e alen du ing he pandemic compa ed o he
p e-pandemic pe iod: 23% o adolescen s epo ed eel-
ing low weekly be o e he pandemic, as compa ed wi h
34–43% in h ee wa es du ing he i s and second yea
o he pandemic. As he pandemic has impac ed di e en
popula ion g oups unequally [6], including adolescen s
[7, 8], i is impo an o iden i y he cha ac e is ics o he
g oups a pa icula isk o men al heal h p oblems and
hose who a e mo e esilien o he ad e se impac o he
pandemic.
The de e io a ion o adolescen s’ men al heal h could
be pa ly explained by he di e en measu es imple-
men ed o educe he sp ead o he COVID-19 i us,
such as social dis ancing, home qua an ines, and emo e
schooling. Many o hese measu es es ic ed con ac
wi h o he people, bo h pee s and adul s ou side he
home, as well as social suppo (e.g., pe cep ions o ha -
ing someone who lis ens and encou ages when needed)
[9], esul ing in de imen al e ec s on adolescen s’ abil-
i y o ul ill hei social needs and de elopmen al asks
[10]. Gi en ha social suppo may se e as a bu e ing
mechanism be ween s ess ul e en s like he COVID-19
pandemic and poo men al heal h [11], adolescen s wi h
limi ed social suppo may ha e been especially ulne -
able o he nega i e impac s o he pandemic. I has also
been sugges ed ha he e ec s o social dis ancing migh
ex end beyond he pandemic [12], and ha he dynamic
o suppo i e ela ionships migh ha e changed du ing
his ime pe iod [13].
The e ec s o he pandemic du ing adolescence a e
no limi ed o pee ela ionships, hey may also ha e an
impac on he quali y o ela ionships be ween pa en s
and hei child en [14], which in u n can con ibu e o
he o e all heal h o adolescen s [15]. Du ing he pan-
demic, adolescen s ha e epo ed lowe le els o pa en-
al suppo han 6mon hs be o e he lockdown [16].
Fu he mo e, Magson e al. [17] obse ed ha abou a
qua e o adolescen s epo ed mo e equen con lic s
wi h hei pa en s du ing he pandemic, which in u n
was associa ed wi h lowe li e sa is ac ion. Families ha e
also aced inancial ha dships du ing he pandemic,
wi h pa en s om low-income and lowe -middle class
amilies being a g ea e isk o educed income and job
loss [18]. This could ha e a ec ed he heal h o you hs,
as associa ions be ween low socioeconomic s a us and
child men al heal h p oblems ha e ecei ed much sup-
po ( o e iew, see Reiss [19]. Simul aneously, many
adolescen s ha e had less oppo uni ies o in e ac wi h
classma es and eache s. This is conce ning, as eache s
and he class oom en i onmen ha e shown o play a
i al ole in suppo ing he well-being o young people
[20, 21]. Since he COVID-19 pandemic began, adoles-
cen s ha e epo ed a dec ease in communica ion wi h
eache s and less emo ional suppo om eache s (e.g.,
eache s lis ening o wo ies and conce ns wi h less
ca e), as measu ed du ing he all o 2020 [22]. How-
e e , one s udy [23] has ound ha connec edness wi h
school pee s did no p edic men al heal h among chil-
d en and ea ly adolescen s du ing he pandemic in he
sp ing and summe o 2020. This could possibly be due
o he ac ha ela ionships wi h o he sou ces (e.g.,
amily) may ha e played a mo e impo an ole when
access o classma es and eache s was limi ed.
New oppo uni ies o in e ac and ob ain social sup-
po ha e also a isen du ing he pandemic, wi h many
adolescen s spending mo e ime wi h hei iends online
in spaces such as social media o compensa e o he loss
o ace- o- ace social in e ac ions [24]. Tu ning o social
media o alk wi h o he s can be one way o coping wi h
he c isis [25]. Howe e , sys ema ic e iews, along wi h
c oss-na ional and single coun y s udies, ha e indica ed
p oblema ic social media use, including addic ion-like
symp oms (e.g., con lic wi h amily and displacemen o
o he ac i i ies due o social media use [26]), o associ-
a e wi h a mul i ude o psychological p oblems such as
dep essi e symp oma ology [27–30]. Mo eo e , i has
been sugges ed ha digi ally media ed social in e ac ions
a e no he same as ace- o- ace expe iences, as spending
mo e i ual ime wi h iends du ing he pandemic has
been associa ed wi h highe le els o dep ession among
adolescen s [31].
A he beginning o he pandemic, educa ion p ac-
ices changed, and online educa ion inc eased. This
may ha e a ec ed adolescen s’ school engagemen
and mo i a ion, wi h e idence showing lowe lea ning
concen a ion, engagemen , and abili y o lea n du ing
online classes han in class oom lea ning [32]. These
expe iences, in u n, migh ha e an impac on adoles-
cen s’ plans o u u e educa ion, which ha e also been
linked o heal h. Fo example, lowe educa ional expec-
a ions (e.g., expec ing an educa ion lowe han uni e -
si y) ha e been associa ed wi h poo e men al heal h in
Page 3 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
e ms o highe le els o ex e nalizing p oblems (e.g.,
hype ac i i y) among you hs [33].
In addi ion o di e en psychosocial asse s, o he
indi idual asse s, such as heal h li e acy, could also
se e as a bu e ing mechanism agains he nega i e
e ec s o he pandemic on adolescen s’ men al heal h.
Du ing he pandemic, he ole o heal h li e acy as a
se o compe encies (e.g., knowledge on heal h issues
and an abili y o seek and assess in o ma ion) neces-
sa y o p omo ing and sus aining one’s heal h and ha
o o he s [34] has g own in impo ance. I has been
impo an o ollowing sa e y egula ions, o seeking
imely help and o inding alid heal h in o ma ion
om among he massi e low o in o ma ion o di e -
en quali y p o ided on he in e ne in pa icula . Low
heal h li e acy has been linked wi h no only di icul ies
in unde s anding COVID-19 in o ma ion and in ec-
ion p e en ion beha io s, bu also wi h poo e men al
heal h [35]. Al eady be o e he pandemic, low heal h
li e acy was ecognized as an independen explana o y
ac o in men al heal h a iance (e.g., eeling low) [36].
The pandemic has also had ad e se e ec s on adoles-
cen s’ sel - a ed heal h, ha is, a pe son’s o e all heal h
s a us [37], especially among hose wi h limi ed social
suppo [38]. This is dis u bing, gi en ha poo e sel -
a ed heal h du ing adolescence has been linked o
heal h p oblems in adul hood [39] and has shown o be
a obus p edic o o mo ali y [40]. Acco ding o p e-
pandemic esea ch, associa ions be ween highe s ess
caused by unce ain y and poo e sel - a ed heal h
ha e also been obse ed [41], whe eas be e sel - a ed
heal h has been linked o be e men al heal h in e ms
o lowe anxie y [42] and highe esilience [43], ha is,
he abili y o main ain one’s men al heal h when ac-
ing ad e si y [44]. Fo hese easons, sel - a ed heal h
could be an impo an ac o in how adolescen s eac
o adap o he s esso s caused by he pandemic.
The di e en e ec s o he pandemic on di e en
indi iduals may also be due o hei socio-demog aphic
cha ac e is ics. A as body o esea ch has shown ha
gi ls al eady epo ed poo e men al heal h in e ms
o dep ession han boys p io o he pandemic ( o
a me a-analysis, see Salk e  al. [45]). P e-pandemic
esea ch [46, 47] has also linked o he cha ac e is ics
o young people, such as olde age and immig an s a-
us, o poo e men al heal h (e.g., dep ession, anxie y).
S udies conduc ed in di e en pa s o he wo ld ha e
shown ha you hs li ing in u ban a eas end o epo
sligh ly poo e well-being han hose li ing in u al
a eas [48, 49], al hough coun y-speci ic di e ences
exis . These indi iduals may be pa icula ly ulne able
o he ad e se e ec s o he pandemic.
The pandemic in heFinnish con ex
Beginning in mid-Ma ch 2020, Finnish schools we e
closed na ionwide o abou wo mon hs [50]. Du ing all
2020 and sp ing 2021, educa ion was empo a ily con-
duc ed in he o m o dis ance lea ning in some egions,
especially uppe educa ion [51]. F om all 2021 un il
sp ing 2022, Finnish comp ehensi e schools emained
ully open. Since he onse o he COVID-19 pandemic,
leisu e cen e s and spo s acili ies ha e closed se e al
imes, wi h closu es las ing a ew weeks o se e al mon hs
[52, 53]. Mos spo s acili ies ha e emained open since
Feb ua y 2022 [54]. As in many coun ies, men al heal h
p oblems ha e inc eased among Finnish adolescen s du -
ing he pandemic. In sp ing 2021, sa is ac ion wi h li e
had dec eased, while anxie y, dep ession and eelings o
loneliness had inc eased om 2019 [55, 56]. Howe e , i
should be no ed ha al eady du ing he las wo decades
p io o he pandemic, Finnish adolescen s’ psychologi-
cal and soma ic heal h complain s (e.g., dep ession and
headaches) had inc eased [57].
In sum, he pandemic has a ec ed he li es o you hs
and hei amilies in many ways. Unde s anding he
implica ions o he COVID-19 pandemic o he men al
heal h o you hs and he po en ial isk and p o ec i e ac-
o s is c ucial o measu es o p omo e pos -pandemic
eco e y. To da e, mos s udies examining he impac o
he pandemic on he men al heal h o adolescen s ha e
ocused on he p e alence o symp oms o dep ession o
anxie y and used a iable-cen e ed app oaches aimed
a p edic ing hei di e en men al heal h ou comes,
wi h indings la gely elying on da a collec ed du ing he
1yea o he pandemic. The men al heal h ou comes o
su i o s o he pandemic may be highly indi idual and
linked o di e en psychosocial and heal h asse s o
esou ces, including p ima y and ins i u ionalized sup-
po sys ems such as amilies and school. To show his
di e si y o men al heal h eac ions and o iden i y ul-
ne abili ies o he pandemic, in his s udy, we adop ed a
pe son-cen e ed app oach, ha is, s a is ical echniques
ha iden i y g oups o indi iduals who sha e pa icula
cha ac e is ics ha a e simila wi hin g oups bu di e -
en be ween g oups [58]. D awing on wo la ge da a se s
o epea ed c oss-sec ional design— he i s a 2yea s
p io o COVID-19 and he second a 2yea s a e he
beginning o he pandemic— he cu en s udy aimed o
iden i y men al heal h p o iles among Finnish adoles-
cen s be o e (2018) and a e he peak o he pandemic
(2022), and hen o analyze which socio-demog aphic,
psychosocial, and o he heal h- ela ed ac o s cha ac e -
ize adolescen s who a e a isk and hose who a e mo e
esilien o he de imen al impac o he pandemic on
men al heal h.
Page 4 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
The speci ic aims o his s udy we e:
1) To iden i y men al heal h p o iles (psychological
complain s, soma ic complain s, li e sa is ac ion, pe -
cei ed loneliness, and p oblema ic social media use)
among Finnish adolescen s be o e and a e he peak
o he COVID-19 pandemic
2) To examine how socio-demog aphic cha ac e is-
ics (gende , age, language o ins uc ion, immi-
g an backg ound, amily a luence, amily s uc u e,
u ban/ u al esidence), psychosocial ac o s (pe -
cei ed social suppo , pe cei ed home a mosphe e,
pa en al moni o ing, pe cep ions o school clima e,
in ensi y o online communica ion), educa ional
expec a ions, heal h li e acy, and sel - a ed heal h a e
associa ed wi h he heal h p o iles be o e and a e
he peak o he pandemic.
Me hods
Pa icipan s andp ocedu e
Da a we e collec ed om wo c oss‐sec ional samples
o Finnish adolescen s in he 5 h, 7 h, and 9 h g ades
in 2018 (N = 3498) and 2022 (N = 3838), as pa o he
Heal h Beha iou in School-aged Child en (HBSC) s udy.
The HBSC s udy is ca ied ou in collabo a ion wi h he
Wo ld Heal h O ganiza ion (WHO) Regional O ice o
Eu ope. Samples we e d awn using a clus e sampling
me hod, wi h schools as he p ima y sampling uni . The
sampling was adjus ed o p o ince, municipali y, and
school size. The collec ion o da a ollowed he p o o-
col o he in e na ional HBSC s udy, ensu ing esponsi-
ble conduc o esea ch [59]. The esponden s answe ed
he online su eys du ing he school day in he sp ing
semes e . Pa icipa ion was olun a y and no pe sonally
iden i iable in o ma ion was collec ed. The su eys we e
app o ed by he E hical Commi ee o he Uni e si y o
Jy askyla.
Measu es
Table 1 p esen s he s udy a iables. Men al heal h
indica o s we e psychological complain s, soma ic
complain s, li e sa is ac ion, pe cei ed loneliness, and
p oblema ic social media use. In o ma ion on socio-
demog aphic cha ac e is ics (immig an backg ound,
amily a luence, amily s uc u e, u ban/ u al esidence),
psychosocial ac o s (pe cei ed social suppo , pe cei ed
home a mosphe e, pa en al moni o ing, pe cep ions
o school clima e, in ensi y o online communica ion),
educa ional expec a ions, heal h li e acy, and sel - a ed
heal h was also collec ed. The adolescen s also epo ed
hei gende (1 = Boy, 2 = Gi l). G ade le el consis ed o
he ollowing ca ego ies: 1 = 5 h g ade (age M = 11.39
in Sample 1/11.38 in Sample 2), 2 = 7 h g ade (age
M = 13.37 in Sample 1/13.52 in Sample 2), and 3 = 9 h
g ade (age M = 15.33 in Sample 1/15.37 in Sample 2). The
language o ins uc ion, which pa ly se ed as an indica-
o o g oup s a us, was based on he eaching language
o he schools (1 = Finnish, 2 = Swedish), as Finland is a
bilingual coun y wi h wo o icial languages, Finnish
being he mo he ongue o he majo i y and Swedish
ha o he linguis ic mino i y. A de ailed desc ip ion o
he ins umen s o he HBSC su ey can be ound in he
HBSC S udy P o ocol by Inchley e al. [59].
S a is ical analysis
Di e ences be ween he key a iables in Samples 1 and
2 we e analyzed using Chi-squa e es s and independen
- es s, wi h Bon e oni-co ec ed p- alues o mul iple
es ing. Co ela ions we e calcula ed using Spea man’s
ank co ela ion, and di e ences be ween he co ela-
ions o samples we e compa ed using Fishe - o-z
ans o ma ions. Men al heal h p o iles, based on i e
indica o s (i.e., psychological complain s, soma ic com-
plain s, li e sa is ac ion, pe cei ed loneliness, and p ob-
lema ic social media use), we e iden i ied sepa a ely o
Samples 1 and 2 using he SPSS TwoS ep Clus e ing
algo i hm. This explo a o y me hod iden i ies subg oups
o adolescen s based on simila i ies in hei cha ac e -
is ics. The numbe o clus e s we e allowed o be au o-
ma ically es ima ed by he analysis me hod on he basis
o he Bayesian in o ma ion c i e ion (BIC), and a ious
ixed numbe s o clus e s we e also es ed. Missing da a
we e handled using lis wise dele ion, and di e ences in
socio-demog aphic cha ac e is ics be ween included and
excluded cases we e examined u he using Chi-squa e
es , analysis o a iance (ANOVA), pos -hoc ANOVA
analysis wi h Bon e oni co ec ion, and Gene alized lin-
ea mixed models wi h mul inomial logis ic eg ession.
The inal clus e solu ion was de e mined on he basis
o clus e quali y (silhoue e coe icien ), size, and in e -
p e abili y. The Chi-squa e es , ANOVA, and pos -hoc
ANOVA analysis wi h Bon e oni co ec ion we e used
o compa e he clus e s. The clus e s we e named on he
basis o he in e p e a ion o he mos no able cha ac e -
is ics ha made up he p o iles.
Gene alized linea mixed models wi h mul inomial
logis ic eg ession we e pe o med sepa a ely o he wo
samples, o assess he associa ions be ween independ-
en a iables and men al heal h p o iles, using he “Good
men al heal h” p o ile as he e e ence ca ego y. A mul i-
le el analysis wi h “school” included as a andom e ec
was chosen on he basis o he s uc u e o he da a, as
he adolescen s we e nes ed wi hin schools. No mul icol-
linea i y was de ec ed among he independen a iables
(Va iance In la ion Fac o (VIF) < 2 in bo h samples).

Page 5 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Table 1 Measu es used in he s udy
Va iable and i ems Response op ions Coding Scale used/adap ed om C onbach’s alpha
Sample 1 Sample 2
Men al heal h indica o s
Psychological complain s
How o en ha e you expe ienced
hese symp oms o e he las
six mon hs?
Abou e e y day
Mo e han once a week
Abou e e y week
Abou e e y mon h
Ra ely o ne e
Numbe o complain s (1 = 0, 2 = 1–2,
3 = 3–4) expe ienced wice a week o
mo e o en
HBSC symp oms checklis [60]. The meas‑
u e has p o en alidi y [60]0.83 0.82
Soma ic complain s
How o en ha e you expe ienced
hese symp oms o e he las six
mon hs?
Abou e e y day
Mo e han once a week
Abou e e y week
Abou e e y mon h
Ra ely o ne e
Numbe o complain s (1 = 0, 2 = 1–2,
3 = 3–4) expe ienced wice a week o
mo e o en
HBSC symp oms checklis [60]. The meas‑
u e has p o en alidi y [60]0.75 0.76
Li e sa is ac ion
Adolescen s we e asked o a e how
sa is ied hey we e wi h hei li es
on a isual scale
10 The bes possible li e—0 The wo s possible
li e The scale was e e sed and used as a
con inuous scale
(0–10)
Can il ladde [61]. The measu e has
shown good es – e es eliabili y and
con e gen alidi y [62]
Pe cei ed loneliness
Do you e e eel lonely? (Sample 1) Yes, e y o en
Yes, qui e o en
Some imes
No
1 = Low loneliness (No / Some imes),
2 = High loneliness (Yes, qui e o en / Yes,
e y o en)
How o en ha e you el lonely
du ing
he las 12 mon hs? (Sample 2)
Ne e
Ra ely
Some imes
Mos o he ime
Always
1 = Low loneliness (Ne e / Ra ely /
Some imes), 2 = High loneliness (Mos o
he ime /Always)
Page 6 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Table 1 (con inued)
Va iable and i ems Response op ions Coding Scale used/adap ed om C onbach’s alpha
Sample 1 Sample 2
P oblema ic social media use
Du ing he pas yea , ha e you No
Yes All yes‑ esponses we e summed ( ange
0–9) and ecoded in o h ee g oups:
no ma i e use s (0 o 1 yes‑ esponses),
isky use s (2 o 5 yes‑ esponses), and
p oblema ic use s (6 o 9 yes‑ esponses)
[30, 63]
Social Media Diso de Scale [26]. The
measu e has p o en alidi y [63]0.82 0.82
Regula ly no iced ha you can only
hink abou he momen ha you
will be able
o use social media again?
Regula ly el dissa is ied because
you wan ed o spend mo e ime on
social media?
O en been in a bad mood because
you couldn’ use social media?
T ied o spend less ime on social
media bu ailed?
Regula ly neglec ed doing o he
hings (e.g., hobbies, spo s)
because
you wan ed o use social media?
Regula ly a gued wi h o he s abou
you own social media usage?
Regula ly lied o you pa en s o
iends abou how much ime you
spend on social media?
O en used social media o escape
om unpleasan eelings?
Ac ually ough wi h you pa en s o
siblings because o you social
media
usage?
Psychosocial ac o s
Pe cei ed home a mosphe e
How would you a e he a mos‑
phe e in
you home?
Ve y good
Qui e good
Nei he good no bad
Qui e bad
Ve y bad
The scale was e e sed and used as a
con inuous a iable Simonsen e al. [64]; Suominen e al. [65]
Pa en al moni o ing
Ma e nal moni o ing (6 i ems)aB own [66] 0.86 0.86
Page 7 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Table 1 (con inued)
Va iable and i ems Response op ions Coding Scale used/adap ed om C onbach’s alpha
Sample 1 Sample 2
Pa e nal moni o ing (6 i ems)aB own [66] 0.89 0.90
How much does you mo he / a he
eally know abou She/he knows a lo
She/he knows some hing
She/he knows no hing
I ha e no mo he , o I do no see he
I ha e no a he , o I do no see him
The las wo esponse op ions we e omi ‑
ed. Mean sco es we e calcula ed o bo h
subscales
Who you iends a e
How you spend you money
Whe e you spend you ime a e
school
Whe e you a e in he e enings
Wha you do in you ee ime
Wha you do on he in e ne
Family suppo
My amily eally ies o help me Ve y s ongly disag ee (1)—Ve y s ongly ag ee
(7) I ems we e compu ed in o a mean sco e Mul i‑dimensional Scale o Pe cei ed
Social Suppo [67]. The measu e has
p o en alidi y [68]
0.97 0.96
I ge he help and emo ional sup‑
po I
need om my amily
I can alk abou my p oblems wi h
my
amily
My amily is willing o help me in
decision‑making
Pee suppo
My iends eally y o help me Ve y s ongly disag ee (1)— Ve y s ongly ag ee
(7) I ems we e compu ed in o a mean sco e Mul i‑dimensional Scale o Pe cei ed
Social Suppo [67]. The measu e has
p o en alidi y [68]
0.96 0.96
I can coun on my iends when
some hing goes w ong
I ha e iends wi h whom I can sha e
my joys and so ows
I can alk abou my p oblems wi h
my
iends
Page 8 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Table 1 (con inued)
Va iable and i ems Response op ions Coding Scale used/adap ed om C onbach’s alpha
Sample 1 Sample 2
Teache suppo
I eel ha my eache s accep me
as I
am
Comple ely ag ee
Ag ee
Nei he ag ee no disag ee
Disag ee
Comple ely disag ee
I ems we e e e sed and compu ed in o a
mean sco e Teache and Classma e Suppo Scale [69].
The measu e has p o en alidi y [70]0.87 0.88
I eel ha my eache s ca e abou
me as
a pe son
I us my eache s a lo
Classma e suppo
The pupils in my class ge on well
wi h each o he Comple ely ag ee
Ag ee
Nei he ag ee no disag ee
Disag ee
Comple ely disag ee
I ems we e e e sed and compu ed in o a
mean sco e Teache and Classma e Suppo Scale [69].
The measu e has p o en alidi y [70]0.81 0.84
Mos pupils in my class a e kind and
help ul
O he pupils accep me he way
I am
School clima e
I eel sa e in his school Comple ely ag ee
Ag ee
Nei he ag ee no disag ee
Disag ee
Comple ely disag ee
I ems we e e e sed and compu ed in o a
mean sco e The School Clima e Index [71] 0.81 0.86
I eel like I belong in his school
In ensi y o online communica ion
How o en do you in e ac wi h he
ollowing people ia he in e ne ? I don’ know/Doesn’ conce n me
Ne e o ha dly e e
A leas e e y week
Daily o almos daily
Se e al imes a day
Almos all he ime
The i s esponse op ion was omi ed.
Following p e ious esea ch [72, 73], all
i ems we e calcula ed in o a mean sco e
EU Kids Online Su ey [74] 0.71 0.74
Close iend(s)
F iends om a la ge iend g oup
People ha you ha e me on
he in e ne
O he people (e.g., pa en s, siblings,
classma es, eache s)
Page 15 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
In his sample (n = 2981), ou p o iles we e obse ed:
(1) “Good men al heal h” (37%, n = 1103), (2) “Mixed psy-
chosoma ic heal h” (17%, n = 499), 3) “Poo men al heal h
and low loneliness” (34%, n = 1011), and 4) “Poo men al
heal h and high loneliness” (12%, n = 368). The silhoue e
coe icien was 0.40, indica ing ai clus e quali y. No a-
bly, he dis ibu ion o men al heal h indica o s in he
di e en p o iles was qui e simila o one p o ile in bo h
samples (i.e., “Good men al heal h”). Howe e , he p o-
po ion o adolescen s belonging o his p o ile di e ed
in he wo samples, wi h ewe adolescen s belonging o
his p o ile in Sample 2 (2022) han in Sample 1 (2018)
(p = 0.001).
Adolescen s in he “Good men al heal h” p o ile
epo ed low p e alence o psychological and soma ic
complain s. The mean alue o li e sa is ac ion (M = 8.19)
was he highes in his p o ile, and all adolescen s
epo ed low loneliness (100%). The majo i y we e no -
ma i e social media use s (71%).
In he “Mixed psychosoma ic heal h” p o ile, he majo -
i y expe ienced one o wo equen psychological (72%)
o soma ic complain s (56%). Thei mean alue o li e
sa is ac ion (M = 7.77) was mode a e, and all he adoles-
cen s epo ed low loneliness (100%). This was he only
p o ile in which all he adolescen s we e no ma i e social
media use s (100%).
In he “Poo men al heal h and low loneliness” p o ile,
mos adolescen s epo ed expe iencing one o wo (46%)
o h ee o ou (41%) equen psychological complain s.
Almos 60 pe cen expe ienced a leas one o wo
soma ic complain s equen ly. The mean alue o li e sa -
is ac ion (M = 7.07) was low. All he adolescen s epo ed
low loneliness (100%). This p o ile had he highes pe -
cen age o isky social media use s (66%), and oughly
one i h we e p oblema ic social media use s (22%).
Table 2 (con inued)
Sample 1 (2018),
N = 3498 Sample 2 (2022),
N = 3838 Signi icance
% (n)/M (SD) % (n)/M (SD)
O he heal h‑ ela ed ac o s
Academic educa ional expec a ionsc ( s. oca ional) 64.71 (704) 58.47 (518) χ2= 8.07, p =0.005
Heal h li e acybχ2= 15.00, p = 0.005
Low 10.2 (238) 8.8 (208) p > 0.05d
Mode a e 55.5 (1301) 61.1 (1446) p <0.001d
High 34.3 (805) 30.2 (714) p = 0.002d
Sel ‑ a ed heal h x= 31.36, p < 0.001
Poo 2.4 (84) 2.1 (79) p > 0.05d
Fai 13.9 (479) 12.9 (487) p > 0.05d
Good 60.1 (2074) 55.7 (2106) p < 0.001d
Excellen 23.6 (813) 29.4 (1111) p < 0.001d
Chi-squa e es o pe cen age compa ison and independen - es o mean compa ison. Sco es anged om 10 o 19 o age, 0 o 10 o li e sa is ac ion, 1 o 5 o
home a mosphe e, 1 o 3 o pa en al moni o ing, 1 o 7 o amily and pee suppo , 1 o 5 o eache and classma e suppo , 1 o 5 o school clima e, and 1 o 5 o
in ensi y o online communica ion.Bold alues deno e s a is ical signi icance
a Numbe o complain s expe ienced mo e han once a week
b Only assessed among 7 h and 9 h g ade adolescen s (sample 1, n = 2457, sample 2, n = 2406)
c Only assessed among 9 h g ade adolescen s (sample 1, n = 1176, sample 2, n = 993)
d Bon e oni-co ec ed p- alues o mul iple es ing
Table 3 Co ela ions o men al heal h indica o s in bo h samples
Spea man’s ank co ela ion
a Highe alues indica e poo e men al heal h
b Highe alues indica e highe li e sa is ac ion
** p < 0.001
1234
Sample 1 (2018)
1 Psychological complain sa–
2 Soma ic complain sa0.45** –
3 Li e sa is ac ionb− 0.40** − 0.26** –
4 Pe cei ed lonelinessa0.37** 0.22** − 0.33** –
5 P oblema ic social media
usea0.26** 0.18** − 0.22** 0.17**
Sample 2 (2022)
1 Psychological complain sa–
2 Soma ic complain sa0.51** –
3 Li e sa is ac ionb− 0.46** − 0.33** –
4 Pe cei ed lonelinessa0.31** 0.25** − 0.32** –
5 P oblema ic social media
usea0.33** 0.23** − 0.28** 0.19**

Page 16 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
The “Poo men al heal h and high loneliness” p o ile
was he only p o ile wi h adolescen s who epo ed high
loneliness (99%) in Sample 2. This p o ile had he high-
es pe cen age o adolescen s epo ing h ee o ou e-
quen psychological (59%) o soma ic complain s (25%).
The mean alue o li e sa is ac ion (M = 5.74) was he
lowes in his p o ile. The majo i y we e isky (52%) o
p oblema ic (20%) social media use s.
Socio‑demog aphic desc ip ion o men al heal h p o iles
Tables 6, 7 p esen desc ip i e esul s om he Chi-
squa e es and pos hoc ANOVA, showing he cha ac-
e is ics o adolescen s in each p o ile. The “Good men al
heal h” p o ile in bo h samples con ained mo e boys han
gi ls, whe eas he o he h ee p o iles con ained mo e
gi ls han boys. The “Soma ically challenged” p o ile in
Sample 1, and he “Poo men al heal h and low lone-
liness” and “Mixed psychosoma ic heal h” p o iles in
Sample 2 had a highe p opo ion o adolescen s whose
language o ins uc ion was Swedish han he “Good
men al heal h” p o iles. The “Poo men al heal h” p o ile
in Sample 1 and he “Poo men al heal h and high lone-
liness” p o ile in Sample 2 had a highe p opo ion o
i s -gene a ion immig an s and adolescen s li ing in a
single-pa en amily o a s ep amily han he “Good men-
al heal h” p o iles.
Fac o s associa ed wi hmen al heal h p o iles
Table8 p esen s he esul s om he mixed e ec mul i-
nomial logis ic eg ession analysis, showing associa ions
be ween socio-demog aphic cha ac e is ics, psychoso-
cial ac o s, educa ional expec a ions, heal h li e acy,
sel - a ed heal h, and men al heal h p o iles, showing he
“Good men al heal h” p o ile as he e e ence ca ego y in
bo h samples.
Table 4 Men al heal h p o iles in sample 1 (2018)
Chi-squa e es o pe cen age compa ison and Pos -hoc ANOVA o mean compa ison ( wo- ailed)
a Numbe o complain s expe ienced mo e han once a week
b P o iles di e ed signi ican ly (p <0.001) using Bon e oni-co ec ed pai wise compa isons
c P o iles di e ed signi ican ly (p = 0.042) using Bon e oni-co ec ed pai wise compa isons
All P o ile 1 P o ile2 P o ile 3 P o ile 4 P o ile compa ison
n = 3149 “Good men al
heal h” (43.7%,
n = 1375)
“Mixed
psychosocial
heal h” (19.9%,
n = 628)
“Soma ically
challenged”
(15.0%, n = 471)
“Poo men al
heal h” (21.4%,
n = 675)
O e all p‑ alue Pai wise
compa ison
%/M (SD) %/M (SD) %/M (SD) %/M (SD) %/M (SD) χ2/F
Sample 1 (2018)
Men al heal h indica o s
Psychological
complain sa2747.51 < 0.001
0 57.5 100.0 8.1 49.0 22.8 All p o iles di e b
1–2 27.7 74.4 51.0 24.4 2, 3, 4 di e b
3–4 14.8 17.5 52.7 2, 4 di e b
Soma ic
complain sa2919.90 < 0.001
0 69.5 100.0 100.0 27.3 1 = 2, 4 di e sb
1–2 26.5 100.0 53.8 3, 4 di e b
3–4 4.1 19.0
Li e sa is ac ion 7.74 (1.77) 8.44 (1.15) 7.48 (1.59) 7.92 (1.28) 6.42 (2.37) 251.64 < 0.001 All p o iles di e b
High loneliness
( s. low) 14.5 0.0 26.4 0.0 43.0 827.20 < 0.001 1 = 3, 2b, 4 di e b
P oblema ic social
media use 1363.10 < 0.001
No ma i e
use 56.1 72.4 55.6 58.2 21.8 2 = 3, o he s
di e b
Risky use 34.3 27.6 44.4 41.8 33.3 2 = 3, o he s
di e c
P oblema ic
use 9.6 44.9
Page 17 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Sample 1 (2018)
A e adjus men o all a iables (model adjus ed b–d),
in 2018, adolescen s belonging o any o he o he h ee
p o iles han he “Good men al heal h” p o ile we e
mo e likely o be gi ls, and o epo a highe in ensi y o
online communica ion. In addi ion, hey we e less likely
o epo excellen sel - a ed heal h han poo sel - a ed
heal h.
Those belonging o he “Mixed psychosocial heal h”
p o ile we e also mo e likely o epo lowe ma e nal
moni o ing, lowe pee suppo , and a less posi i e home
a mosphe e and school clima e, and o ha e academic
educa ional expec a ions, and we e less likely o li e in an
u ban esidence han hose in he “Good men al heal h”
p o ile.
Those belonging o he “Soma ically challenged” p o-
ile we e also mo e likely o be in he 7 h g ade, o ha e
Swedish as opposed o Finnish as hei language o
ins uc ion, and o epo highe pee suppo and lowe
classma e suppo , and we e less likely o epo medium
amily a luence han low amily a luence han hose in
he “Good men al heal h” p o ile.
Those belonging o he “Poo men al heal h” p o ile
we e mo e likely o epo lowe ma e nal moni o ing,
lowe amily suppo , lowe eache suppo , and a less
posi i e home a mosphe e and school clima e, and we e
less likely o li e in an u ban esidence han hose in he
“Good men al heal h” p o ile.
A e adjus men o all a iables, amily s uc u e,
immig an backg ound, pa e nal moni o ing and heal h
li e acy we e no associa ed wi h p o ile membe ship
(p > 0.05).
Fo he school-le el a iance in he models, see Addi-
ional ile1: TableS4.
Table 5 Men al heal h p o iles in Sample 2 (2022)
Chi-squa e es o pe cen age compa ison and Pos -hoc ANOVA o mean compa ison ( wo- ailed)
a Numbe o complain s expe ienced mo e han once a week
b P o iles di e ed signi ican ly (p < 0.001) using Bon e oni-co ec ed pai wise compa isons
c P o iles di e ed signi ican ly (p = 0.015) using Bon e oni-co ec ed pai wise compa isons
d P o iles di e ed signi ican ly (p = 0.004) using Bon e oni-co ec ed pai wise compa isons
All P o ile 1 P o ile 2 P o ile 3 P o ile 4 P o ile compa ison
n = 2981 “Good men al
heal h” (37.0%,
n = 1103)
“Mixed
psychosoma ic
heal h” (16.7%,
n = 499)
“Poo men al
heal hand low
loneliness”
(33.9%,
n = 1011)
“Poo men al
heal h and high
loneliness”
(12.3%, n = 368)
O e all p‑ alue Pai wise
compa ison
%/M (SD) %/M (SD) %/M (SD) %/M (SD) %/M (SD) χ2/F
Sample 2 (2022)
Men al heal h indica o s
Psychological
complain sa2453.62 < 0.001
0 48.1 100.0 27.7 13.9 14.1 3 = 4, o he s di e b
1–2 30.9 72.3 45.5 27.2 2, 3, 4 di e b
3–4 21.0 40.6 58.7 3, 4 di e b
Soma ic
complain sa1264.00 < 0.001
0 62.1 100.0 44.3 40.4 32.1 2 = 3, o he s di e c
1–2 30.6 55.7 46.9 43.5 3 = 4, 2 di e sd
3–4 7.3 12.8 24.5 3, 4 di e b
Li e sa is ac ion 7.44 (1.66) 8.19 (1.00) 7.77 (1.32) 7.07 (1.58) 5.74 (2.24) 293.31 < 0.001 All p o iles di e b
High loneliness
( s. low) 12.2 0.0 0.0 0.0 98.9 2944.09 < 0.001 1 = 2 = 3, 4 di e sb
P oblema ic social
media use 1437.46 < 0.001
No ma i e
use 50.2 70.5 100.0 11.8 27.4 All p o iles di e b
Risky use 39.9 29.5 66.4 52.4 All p o iles di e b
P oblema ic
use 9.9 21.9 20.1 3 = 4
Page 18 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Sample 2 (2022)
A e adjus men o all a iables (model adjus ed b–d),
in 2022, adolescen s belonging o any o he o he h ee
p o iles han he “Good men al heal h” p o ile we e
mo e likely o be gi ls, and o epo lowe eache
suppo .
Those belonging o he “Mixed psychosoma ic heal h”
p o ile we e also mo e likely o ha e Swedish as hei
a numbe o complain s expe ienced mo e han once a week.
Sample 2 (2022)Sample 1 (2018)
Psychological complain s a
0
Somac complain s a
0
Pe cei ed loneliness
Low
P oblemac social media use
No ma e use
Risky use
Li e sas acon
“Good men al heal h” (P o ile 1)
Psychological complain s a
0 1-2
Somac complain s a
1-2
Pe cei ed loneliness
Low
P oblemac social media use
No ma e use
Risky use
Li e sas acon
“Poo men al heal h” (P o ile 4)
Psychological complain s a
0 1-2 3-4
Somac complain s a
0 1-2 3-4
Pe cei ed loneliness
Low High
P oblemac social media use
No ma e use
Risky use
P oblemac use
Li e sas acon
“Poo men al heal h and high loneliness” (P o ile 4)
Psychological complain sa
0
Somac complain s a
0
Pe cei ed loneliness
Low
P oblemac
social media use
No ma e use
Risky use
Li e sas acon
Psychological complain s a
0 1-2
Somac complain s a
0 1-2
Pe cei ed loneliness
Low
P oblemac
social media use
No ma e use
Li e sas acon
Li e sas acon
Li e sas acon
Psychological complain s a
0 1-2 3-4
Psychological complain s a
0 1-2 3-4
Somac complain s a
0 1-2 3-4
Somac complain s a
0 1-2 3-4
Pe cei ed loneliness
Low
Pe cei ed loneliness
Low High
P oblemac social media use
No ma e use
Risky use
P oblemac use
P oblemac social media use
No ma e use
Risky use
P oblemac use
“Poo men al heal h and low loneliness” (P o ile 3)
“Mixed psychosomac heal h” (P o ile 2)
“Good men al heal h” (P o ile 1)
“Somacally challenged” (P o ile 3)
“Mixed psychosocial heal h” (P o ile 2)
Psychological complain s a
0 1-2 3-4
Somac complain s a
0
Pe cei ed loneliness
Low High
P oblemac social media use
No ma e use
Risky use
Li e sas acon
Fig. 1 S acked ba plo s and box plo s showing dis ibu ion o men al heal h indica o s in each p o ile in bo h samples
Page 19 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Table 6 Di e ences be ween p o iles in e ms o socio‑demog aphic, psychosocial, and o he heal h‑ ela ed ac o s in Sample 1
(2018)
All P o ile 1 P o ile 2 P o ile 3 P o ile 4 P o ile compa ison
n =
974–
3149
“Good
men al
heal h”
(n = 386–
1375)
“Mixed
psychosocial
heal h” (n = 195–
628)
“Soma ically
challenged”
(n = 148–471)
“Poo men al
heal h” (n = 245–
675)
O e all p‑ alue Pai wise
compa ison
%/M
(SD)%/M (SD) %/M (SD) %/M (SD) %/M (SD) χ2/F
Sample 1 (2018)
Socio‑demog aphic cha ac e is ics
Gende , emale ( s.
male) 51.2 39.7 56.1 58.6 65.1 140.79 < 0.001 1 and 2c, 1 and 3c,
1 and 4c, 2 and 4d
di e
G ade 48.46 < 0.001
5 h 30.4 35.9 30.4 25.1 23.0 1 and 3c, 1 and 4c, 2
and 4e di e
7 h 36.5 34.4 36.8 41.0 37.5 No di e ences
9 h 33.1 29.7 32.8 34.0 39.6 1 and 4c di e
Language o ins uc‑
ion, Swedish ( s.
Finnish)
19.4 16.9 21.5 24.2 19.3 14.00 0.003 1 and 3c di e
Rela i e amily
a luence 20.83 0.002
Low 17.1 15.6 19.1 18.3 17.8 No di e ences
Medium 57.0 60.9 55.4 50.5 54.8 1 and 3c, 1 and 4e
di e
High 25.9 23.5 25.5 31.2 27.4 1 and 3d di e
Family s uc u e 36.14 < 0.001
Nuclea amily 74.7 79.2 73.5 73.4 67.2 1 and 2e, 1 and 4c
di e
Single‑pa en
amily 13.4 11.0 14.8 13.2 17.2 1 and 4c di e
S ep‑ amily 11.9 9.7 11.7 13.4 15.6 1 and 4c di e
U ban esidence
( s. u al) 54.9 59.4 50.7 51.7 51.9 19.93 < 0.001 1 and 2d, 1 and 3e, 1
and 4d di e
Immig an back‑
g ound 18.62 0.005
Fi s ‑gene a ion
immig an 4.3 3.3 3.1 4.7 7.0 1 and 4c, 2 and 4e
di e
Second‑gene a‑
ion immig an 7.1 7.1 6.5 7.5 7.2 No di e ences
Na i e (non‑
immig an ) 88.7 89.6 90.5 87.7 85.8 No di e ences
Psychosocial ac o s
Pe cei ed home
a mosphe e 4.32
(0.78) 4.55 (0.59) 4.23 (0.73) 4.40 (0.67) 3.90 (0.99) 122.94 < 0.001 All p o iles di e c
Pa en al moni o inga
Ma e nal moni‑
o ing 2.44
(0.45) 2.53 (0.40) 2.41 (0.44) 2.48 (0.42) 2.28 (0.50) 36.07 < 0.001 1 and 2c, 1 and 4c,
2 and 4c, 3 and 4c
di e
Pa e nal moni o ‑
ing 2.24
(0.53) 2.36 (0.50) 2.23 (0.52) 2.24 (0.51) 2.04 (0.56) 37.07 < 0.001 1 and 2c, 1 and 3d,
1 and 4c, 2 and 4c, 3
and 4c di e
Family suppo 5.70
(1.63) 6.05 (1.53) 5.57 (1.52) 5.89 (1.40) 4.99 (1.83) 71.63 < 0.001 1 and 2c, 1 and 4c,
2 and 3d, 2 and 4c, 3
and 4c di e
Page 20 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Chi-squa e es o pe cen age compa ison and Pos -hoc ANOVA o mean compa ison ( wo- ailed)
a Answe ed only by 7 h and 9 h g ade adolescen s (n = 2191)
b Answe ed only by 9 h g ade adolescen s (n = 1041)
c P o iles di e ed signi ican ly (p < 0.001) when Bon e oni-co ec ed pai wise compa isons we e used
d P o iles di e ed signi ican ly (p < 0.01) when Bon e oni-co ec ed pai wise compa isons we e used
e P o iles di e ed signi ican ly (p < 0.05) when Bon e oni-co ec ed pai wise compa isons we e used
Table 6 (con inued)
All P o ile 1 P o ile 2 P o ile 3 P o ile 4 P o ile compa ison
n =
974–
3149
“Good
men al
heal h”
(n = 386–
1375)
“Mixed
psychosocial
heal h” (n = 195–
628)
“Soma ically
challenged”
(n = 148–471)
“Poo men al
heal h” (n = 245–
675)
O e all p‑ alue Pai wise
compa ison
%/M
(SD)%/M (SD) %/M (SD) %/M (SD) %/M (SD) χ2/F
Pee suppo 5.47
(1.64) 5.63 (1.55) 5.23 (1.67) 5.78 (1.40) 5.14 (1.85) 24.20 < 0.001 1 and 2c, 1 and 4c,
2 and 3c, 3 and 4c
di e
Teache suppo 3.85
(0.93) 4.11 (0.77) 3.81 (0.89) 3.85 (0.88) 3.37 (1.10) 105.28 < 0.001 1 and 2c, 1 and 3c,
1 and 4c, 2 and 4c, 3
and 4c di e
Classma e suppo 3.90
(0.77) 4.09 (0.65) 3.79 (0.76) 3.87 (0.71) 3.62 (0.92) 66.89 < 0.001 1 and 4c, 1 and 2c,
1 and 3c, 2 and 4c, 3
and 4c di e
Pe cei ed school
clima e 4.15
(0.86) 4.43 (0.67) 4.04 (0.85) 4.19 (0.71) 3.66 (1.06) 140.30 < 0.001 1 and 2c, 1 and 3c,
1 and 4c, 2 and 3e,
2 and 4c, 3 and 4c
di e
In ensi y o
online communi‑
ca ion
3.02
(0.85) 2.92 (0.79) 2.97 (0.85) 3.08 (0.80) 3.22 (0.96) 19.64 < 0.001 1 and 2d, 1 and 4c,
2 and 4c, 3 and 4e
di e
O he heal h‑ ela ed ac o s
Academic educa‑
ional expec a ionsb
( s. oca ional)
67.2 65.5 75.4 71.6 60.8 12.26 0.007 2 and 4d di e
Heal h li e acya96.91 < 0.001
Low 9.2 5.7 8.0 7.1 17.6 1 and 4c, 2 and 4c, 3
and 4c di e
Mode a e 56.2 52.0 64.4 55.1 57.1 1 and 2c di e
High 34.6 42.3 27.6 37.8 25.3 1 and 2c, 1 and 4c,
2 and 3e, 3 and 4d
di e
Sel ‑ a ed heal h 412.48 < 0.001
Poo 2.2 0.2 1.1 1.3 7.9 1 and 2e, 1 and 3e,
1 and 4c, 2 and 4c, 3
and 4c di e
Fai 14.0 6.4 17.0 12.3 27.9 1 and 2c, 1 and 3c,
1 and 4c, 2 and 4c, 3
and 4c di e
Good 60.5 59.8 66.0 68.2 51.5 1 and 3d, 1 and 4d,
2 and 4c, 3 and 4c
di e
Excellen 23.3 33.5 15.9 18.3 12.8 1 and 2c, 1 and 3c,
1 and 4c di e

Page 21 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Table 7 Di e ences be ween p o iles in e ms o socio‑demog aphic, psychosocial, and o he heal h‑ ela ed ac o s in Sample 2
(2022)
All P o ile 1 P o ile 2 P o ile 3 P o ile 4 P o ile compa ison
n = 738–2981 “Good men al
heal h” (n = 232–
1103)
“Mixed
psychosoma ic
heal h”
(n = 124–499)
“Poo men al
heal h and low
loneliness”
(n = 254–1011)
“Poo men al
heal h and high
loneliness”
(n = 128–368)
O e all p‑ alue Pai wise
compa ison
%/M (SD) %/M (SD) %/M (SD) %/M (SD) %/M (SD) χ2/F
Sample 2 (2022)
Socio‑demog aphic cha ac e is ics
Gende , emale ( s.
male)
54.7 39.6 51.6 65.3 75.3 209.56 < 0.001 1 and 2c, 1 and 3c,
1 and 4c, 2 and 3c,
2 and 4c, 3 and 4d
di e
G ade 85.70 < 0.001
5 h 36.7 44.3 40.5 32.0 21.2 1 and 3c, 1 and 4c,
2 and 3d, 2 and 4c,
3 and 4d di e
7 h 36.2 33.2 32.5 39.7 40.5 1 and 3e, 2 and 3e
di e
9 h 27.2 22.5 27.1 28.3 38.3 1 and 3e, 1 and 4c,
2 and 4d, 3 and 4d
di e
Language o ins uc‑
ion, Swedish ( s.
Finnish)
35.3 30.3 39.7 40.4 30.2 31.94 < 0.001 1 and 2d, 1 and 3c,
2 and 4e, 3 and 4d
di e
Rela i e amily a lu‑
ence
22.76 < 0.001
Low 16.8 17.8 14.0 14.8 23.4 2 and 4d, 3 and 4d
di e
Medium 56.4 57.4 59.1 55.4 52.2 No di e ences
High 26.8 24.8 26.9 29.8 24.5 No di e ences
Family s uc u e 40.23 < 0.001
Nuclea amily 69.6 73.9 72.8 67.4 58.2 1 and 3d, 1 and 4c,
2 and 4c, 3 and 4e
di e
Single‑pa en
amily
20.4 18.8 15.8 21.8 27.7 1 and 4d, 2 and 3e,
2 and 4c di e
S ep‑ amily 10.0 7.3 11.4 10.8 14.0 1 and 3e, 1 and 4d
di e
U ban esidence ( s.
u al)
57.2 57.8 53.1 57.7 59.8 4.62 0.202 No di e ences
Immig an back‑
g ound
37.01 < 0.001
Fi s ‑gene a ion
immig an
3.4 3.0 3.7 2.5 6.5 1 and 4e, 3 and 4d
di e
Second‑gene a ion
immig an
6.3 6.0 3.9 6.1 11.6 1 and 4d, 2 and 4c,
3 and 4d di e
Na i e (non‑immi‑
g an )
90.3 91.1 92.4 91.5 81.9 1 and 4c, 2 and 4c, 3
and 4c di e
Psychosocial ac o s
Pe cei ed home
a mosphe e
4.28 (0.80) 4.57 (0.59) 4.45 (0.65) 4.11 (0.80) 3.69 (1.05) 156.82 < 0.001 1 and 2e, 1 and 3c,
1 and 4c, 2 and 3c,
2 and 4c, 3 and 4 c
di e
Pa en al moni o inga
Ma e nal moni‑
o ing
2.49 (0.44) 2.59 (0.39) 2.56 (0.40) 2.39 (0.44) 2.31 (0.51) 63.09 < 0.001 1 and 3c, 1 and 4c,
2 and 3c, 2 and 4c,
3 and 4e di e
Pa e nal moni o ‑
ing
2.30 (0.55) 2.45 (0.50) 2.41 (0.49) 2.18 (0.54) 1.99 (0.62) 86.44 < 0.001 1 and 3c, 1 and 4c,
2 and 3c, 2 and 4c,
3 and 4c di e
Page 22 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Chi-squa e es o pe cen age compa ison and Pos -hoc ANOVA o mean compa ison ( wo- ailed)
a Answe ed only by 7 h and 9 h g ade adolescen s (n = 1888)
b Answe ed only by 9 h g ade adolescen s (n = 810)
c P o iles di e ed signi ican ly (p < 0.001) when Bon e oni-co ec ed pai wise compa isons we e used
d P o iles di e ed signi ican ly (p < 0.01) when Bon e oni-co ec ed pai wise compa isons we e used
e P o iles di e ed signi ican ly (p < 0.05) when Bon e oni-co ec ed pai wise compa isons we e used
Table 7 (con inued)
All P o ile 1 P o ile 2 P o ile 3 P o ile 4 P o ile compa ison
n = 738–2981 “Good men al
heal h” (n = 232–
1103)
“Mixed
psychosoma ic
heal h”
(n = 124–499)
“Poo men al
heal h and low
loneliness”
(n = 254–1011)
“Poo men al
heal h and high
loneliness”
(n = 128–368)
O e all p‑ alue Pai wise
compa ison
%/M (SD) %/M (SD) %/M (SD) %/M (SD) %/M (SD) χ2/F
Family suppo 5.54 (1.64) 6.07 (1.40) 5.80 (1.50) 5.31 (1.56) 4.24 (1.83) 144.41 < 0.001 1 and 2d, 1 and 3c,
1 and 4c, 2 and 3c,
2 and 4c, 3 and 4c
di e
Pee suppo 5.42 (1.63) 5.70 (1.47) 5.54 (1.56) 5.43 (1.55) 4.36 (1.95) 68.01 < 0.001 1 and 3c, 1 and 4c,
2 and 4c, 3 and 4c
di e
Teache suppo 3.93 (0.92) 4.24 (0.75) 3.96 (0.92) 3.81 (0.86) 3.26 (1.11) 124.80 < 0.001 1 and 2c, 1 and 3c,
1 and 4c, 2 and 3e,
2 and 4c, 3 and 4c
di e
Classma e suppo 3.76 (0.84) 4.02 (0.70) 3.88 (0.74) 3.64 (0.85) 3.14 (0.97) 121.72 < 0.001 1 and 2d, 1 and 3c,
1 and 4, 2 and 3c,
2 and 4c, 3 and 4c
di e
Pe cei ed school
clima e
3.92 (0.94) 4.27 (0.74) 4.05 (0.83) 3.77 (0.91) 3.10 (1.13) 179.77 < 0.001 1 and 2c, 1 and 3c,
1 and 4c, 2 and 3c,
2 and 4c, 3 and 4c
di e
In ensi y o
online communi‑
ca ion
3.03 (0.94) 2.93 (0.94) 3.04 (0.90) 3.14 (0.93) 2.98 (1.03) 8.31 < 0.001 1 and 3c di e
O he heal h‑ ela ed ac o s
Academic educa ional
expec a ionsb ( s.
oca ional)
62.9 69.0 62.9 61.0 55.5 7.07 0.070 No di e ences
Heal h li e acya56.54 < 0.001
Low 8.0 4.2 4.0 9.1 17.3 1 and 3d, 1 and 4c,
2 and 3e, 2 and 4c,
3 and 4d di e
Mode a e 62.2 63.4 62.0 63.0 58.1 No di e ences
High 29.8 32.4 34.0 27.9 24.6 No di e ences
Sel ‑ a ed heal h 355.37 < 0.001
Poo 1.9 0.4 0.8 2.3 7.1 1 and 3d, 1 and 4c, 2
and 4c, 3 and 4c di e
Fai 13.9 5.2 8.4 19.8 31.3 1 and 3c, 1 and 4c,
2 and 3c, 2 and 4c,
3 and 4c di e
Good 59.7 59.1 65.7 60.7 50.8 1 and 4e, 2 and 4c,
3 and 4d di e
Excellen 24.5 35.4 25.1 17.2 10.9 1 and 2c, 1 and 3c,
1 and 4c, 2 and 3d,
2 and 4c, 3 and 4e
di e
Page 23 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Table 8 C ude and adjus ed OR be ween key a iables and men al heal h p o iles in Sample 1 (2018) and Sample 2 (2022)
Va iable Sample 1 (2018) P o ile ( e e ence: p o ile 1—“Good men al heal h”) Sample 2 (2022) P o ile ( e e ence: p o ile 1— “Good men al heal h”)
P o ile 2—“Mixed
psychosocial heal h” P o ile 3—“Soma ically
challenged” P o ile 4—“Poo men al
heal h” P o ile 2—“Mixed
psychosoma ic heal h” P o ile 3—“Poo men al
heal h and low loneliness” P o ile 4—“Poo men al
heal h and high loneliness”
OR (CI 95%) p‑ alue OR (CI 95%) p‑ alue OR (CI 95%) p‑ alue OR (CI 95%) p‑ alue OR (CI 95%) p‑ alue OR (CI 95%) p‑ alue
Socio‑demog aphic cha ac e is ics
Gende , emale ( e .
male)
C ude 1.95 (1.61–2.36) <0.001 2.16 (1.74–2.67) <0.001 2.84 (2.34–3.45) < 0.001 1.64 (1.32–2.04) < 0.001 2.93 (2.44–3.51) < 0.001 4.49 (3.42–5.89) < 0.001
Adjus eda1.94 (1.59–2.36) < 0.001 2.11 (1.69–2.63) < 0.001 2.94 (2.40–3.57) < 0.001 1.61 (1.28–2.02) < 0.001 3.11 (2.56–3.77) < 0.001 5.69 (4.18–7.76) < 0.001
Adjus edb1.81 (1.45–2.27) < 0.001 1.82 (1.42–2.33) < 0.001 2.53 (1.98–3.25) < 0.001 1.46 (1.13–1.90) 0.004 2.49 (1.98–3.14) < 0.001 4.87 (3.25–7.28) <0.001
G ade ( e . 5)
7 h C ude 1.22 (0.96‑ 1.54) 0.108 1.71 (1.32–2.22) < 0.001 1.70 (1.33–2.16) < 0.001 1.08 (0.82–1.41) 0.600 1.56 (1.24–1.97) < 0.001 2.69 (1.91–3.79) < 0.001
Adjus eda1.21 (0.95–1.55) 0.127 1.67 (1.27–2.21) <0.001 1.58 (1.22–2.04) < 0.001 1.20 (0.90–1.60) 0.206 1.55 (1.21–1.99) < 0.001 2.86 (1.97–4.13) <0.001
Adjus edb0.89 (0.68–1.18) 0.428 1.39 (1.02–1.89) 0.036 0.84 (0.61–1.14) 0.254 1.06 (0.77–1.46) 0.730 1.18 (0.89–1.57) 0.246 1.79 (1.11–2.90) 0.017
9 h C ude 1.28 (1.01–1.63) 0.044 1.64 (1.25–2.15) < 0.001 2.08 (1.63–2.64) <0.001 1.32 (0.99–1.78) 0.062 1.62 (1.25–2.09) <0.001 3.65 (2.55–5.21) < 0.001
Adjus eda1.30 (1.01–1.67) 0.040 1.63 (1.22–2.16) <0.001 2.02 (1.56–2.60) < 0.001 1.35 (0.99–1.83) 0.056 1.58 (1.20–2.07) < 0.001 3.56 (2.42–5.23) <0.001
Adjus edb0.90 (0.68–1.20) 0.470 1.28 (0.93–1.76) 0.130 0.91 (0.67–1.23) 0.530 0.99 (0.70–1.40) 0.968 0.99 (0.73–1.34) 0.944 1.81 (1.10–2.98) 0.020
Language o
ins uc ion,
Swedish ( e .
Finnish)
C ude 1.30 (0.99–1.69) 0.056 1.57 (1.21–2.02) <0.001 1.10 (0.84–1.43) 0.495 1.52 (1.17–1.95) < 0.001 1.40 (1.11–1.77) 0.005 1.02 (0.71–1.47) 0.914
Adjus eda1.21 (0.90–1.63) 0.197 1.45 (1.09–1.93) 0.011 0.98 (0.73–1.32) 0.904 1.48 (1.11–1.96) 0.007 1.63 (1.27–2.11) <0.001 1.12 (0.78–1.60) 0.540
Adjus edb1.17 (0.84–1.61) 0.356 1.46 (1.06–2.01) 0.019 0.91 (0.65–1.29) 0.611 1.73 (1.27–2.35) <0.001 1.83 (1.39–2.41) < 0.001 1.20 (0.75–1.94) 0.447
Rela i e amily a luence ( e . low)
Medium C ude 0.74 (0.57–0.95) 0.020 0.71 (0.53–0.94) 0.019 0.79 (0.61–1.02) 0.067 1.26 (0.93–1.72) 0.142 1.11 (0.87–1.43) 0.390 0.67 (0.49–0.91) 0.011
Adjus eda0.73 (0.55–0.96) 0.025 0.65 (0.48–0.89) 0.007 0.88 (0.66–1.17) 0.370 1.26 (0.90–1.77) 0.180 1.15 (0.87–1.52) 0.335 0.92 (0.63–1.34) 0.680
Adjus edb0.84 (0.62–1.13) 0.249 0.69 (0.50–0.96) 0.027 0.93 (0.67–1.30) 0.672 1.41 (0.95–2.08) 0.088 1.19 (0.86–1.65) 0.297 1.57 (0.94–2.64) 0.085
High C ude 0.88 (0.65–1.18) 0.394 1.13 (0.82–1.55) 0.448 1.02 (0.76–1.36) 0.899 1.35 (0.95–1.91) 0.093 1.35 (1.02–1.78) 0.033 0.72 (0.50–1.03) 0.071
Adjus eda0.84 (0.61–1.16) 0.285 0.99 (0.71–1.40) 0.971 1.13 (0.82–1.57) 0.457 1.22 (0.83–1.79) 0.306 1.33 (0.97–1.81) 0.075 0.91 (0.60–1.40) 0.683
Adjus edb0.97 (0.69–1.37) 0.865 0.97 (0.67–1.41) 0.889 1.17 (0.80–1.71) 0.419 1.31 (0.85–2.03) 0.218 1.23 (0.85–1.77) 0.277 1.34 (0.75–2.39) 0.317
Family s uc u e ( e . nuclea amily)
Single‑pa en
amily
C ude 1.44 (1.09–1.92) 0.011 1.30 (0.94–1.79) 0.113 1.82 (1.39–2.39) <0.001 0.87 (0.64–1.18) 0.362 1.38 (1.09–1.75) 0.007 1.85 (1.35–2.53) <0.001
Adjus eda1.35 (1.00–1.83) 0.050 1.23 (0.88–1.73) 0.224 1.78 (1.33–2.38) <0.001 0.99 (0.72–1.37) 0.947 1.50 (1.16–1.93) 0.002 1.70 (1.21–2.40) 0.002
Adjus edb1.20 (0.86–1.67) 0.286 1.10 (0.76–1.60) 0.609 1.34 (0.95–1.90) 0.097 0.91 (0.63–1.32) 0.623 1.40 (1.04–1.89) 0.028 1.46 (0.94–2.28) 0.096
S ep‑ amily C ude 1.30 (0.96–1.77) 0.096 1.50 (1.08–2.08) 0.015 1.90 (1.43–2.52) <0.001 1.60 (1.09–2.34) 0.015 1.71 (1.23–2.37) <0.001 2.54 (1.68–3.83) < 0.001
Adjus eda1.33 (0.97–1.82) 0.080 1.42 (1.01–1.99) 0.045 1.87 (1.39–2.51) < 0.001 1.71 (1.16–2.52) 0.007 1.79 (1.27–2.51) < 0.001 2.47 (1.59–3.83) <0.001
Adjus edb1.19 (0.85–1.66) 0.323 1.40 (0.98–2.00) 0.066 1.40 (0.99–1.99) 0.056 1.39 (0.90–2.13) 0.136 1.27 (0.86–1.87) 0.238 1.50 (0.87–2.59) 0.149
U ban esidence
( e . u al)
C ude 0.71 (0.58–0.87) <0.001 0.73 (0.59–0.91) 0.004 0.75 (0.62–0.91) 0.004 0.81 (0.64–1.03) 0.085 0.99 (0.81–1.21) 0.923 1.14 (0.86–1.53) 0.361
Adjus eda0.73 (0.59–0.91) 0.004 0.84 (0.67–1.06) 0.148 0.72 (0.58–0.89) 0.003 0.88 (0.68–1.13) 0.318 1.03 (0.83–1.29) 0.770 0.96 (0.71–1.30) 0.796
Adjus edb0.74 (0.59–0.94) 0.012 0.86 (0.67–1‑11) 0.253 0.74 (0.58–0.95) 0.019 0.94 (0.72–1.24) 0.678 1.15 (0.90–1.47) 0.270 1.03 (0.70–1.54) 0.868
Page 24 o 33
Gus a ssone al. Child and Adolescen Psychia y and Men al Heal h (2023) 17:54
Table 8 (con inued)
Va iable Sample 1 (2018) P o ile ( e e ence: p o ile 1—“Good men al heal h”) Sample 2 (2022) P o ile ( e e ence: p o ile 1— “Good men al heal h”)
P o ile 2—“Mixed
psychosocial heal h” P o ile 3—“Soma ically
challenged” P o ile 4—“Poo men al
heal h” P o ile 2—“Mixed
psychosoma ic heal h” P o ile 3—“Poo men al
heal h and low loneliness” P o ile 4—“Poo men al
heal h and high loneliness”
OR (CI 95%) p‑ alue OR (CI 95%) p‑ alue OR (CI 95%) p‑ alue OR (CI 95%) p‑ alue OR (CI 95%) p‑ alue OR (CI 95%) p‑ alue
Immig an backg ound ( e . na i e)
Fi s ‑gene a ion
immig an
C ude 0.91 (0.53–1.57) 0.730 1.45 (0.86–2.44) 0.167 2.19 (1.44–3.34) < 0.001 1.19 (0.66–2.15) 0.563 0.79 (0.46–1.35) 0.385 2.47 (1.40–4.35) 0.002
Adjus eda0.92 (0.52–1.63) 0.782 1.26 (0.72–2.21) 0.423 1.56 (0.95–2.55) 0.079 1.21 (0.64–2.29) 0.550 0.80 (0.44–1.46) 0.475 1.89 (0.94–3.78) 0.072
Adjus edb0.86 (0.46–1.59) 0.620 0.80 (0.40–1.58) 0.513 1.36 (0.75–2.45) 0.314 1.15 (0.57–2.32) 0.696 0.66 (0.33–1.32) 0.237 1.26 (0.51–3.14) 0.615
Second‑gene a ion
immig an
C ude 0.91 (0.62–1.33) 0.614 1.09 (0.73–1.63) 0.675 1.07 (0.74–1.53) 0.732 0.65 (0.38–1.11) 0.115 1.01 (0.69–1.46) 0.972 2.03 (1.32–3.12) 0.001
Adjus eda0.87 (0.58–1.31) 0.510 1.14 (0.75–1.72) 0.545 1.03 (0.70–1.52) 0.883 0.68 (0.39–1.19) 0.175 1.00 (0.66–1.51) 0.993 1.88 (1.14–3.09) 0.013
Adjus edb0.77 (0.50–1.19) 0.236 1.11 (0.71–1.74) 0.648 0.75 (0.47–1.20) 0.228 0.49 (0.26–0.94) 0.033 0.85 (0.53–1.36) 0.497 1.10 (0.57–2.09) 0.784
Psychosocial ac o s
Pe cei ed home
a mosphe e
C ude 0.50 (0.44–0.58) < 0.001 0.69 (0.58–0.81) <0.001 0.32 (0.28–0.37) < 0.001 0.74 (0.63–0.88) < 0.001 0.40 (0.35–0.46) < 0.001 0.24 (0.20–0.28) < 0.001
Adjus eda0.51 (0.44–0.59) <0.001 0.76 (0.64–0.90) 0.002 0.36 (0.31–0.42) < 0.001 0.76 (0.64–0.92) 0.004 0.42 (0.36–0.49) < 0.001 0.26 (0.22–0.32) <0.001
Adjus edb0.64 (0.54–0.77) < 0.001 0.98 (0.80–1.20) 0.833 0.56 (0.47–0.67) < 0.001 0.99 (0.79–1.25) 0.955 0.60 (0.49–0.72) <0.001 0.60 (0.46–0.77) < 0.001
Pa en al moni o ing
Ma e nal moni‑
o ing
C ude10.52 (0.39–0.68) < 0.001 0.76 (0.57–1.03) 0.078 0.29 (0.23–0.37) < 0.001 0.78 (0.56–1.10) 0.154 0.40 (0.30–0.52) < 0.001 0.27 (0.20–0.38) <0 .001
Adjus eda1 0.40 (0.30–0.54) < 0.001 0.60 (0.44–0.83) 0.002 0.21 (0.16–0.28) < 0.001 0.65 (0.45–0.94) 0.021 0.30 (0.22–0.40) < 0.001 0.17 (0.11–0.24) < 0.001
Adjus edc1 0.41 (0.26–0.64) < 0.001 0.87 (0.54–1.41) 0.580 0.44 (0.28–0.69) < 0.001 0.71 (0.42–1.20) 0.200 0.44 (0.28–0.69) <0.001 0.63 (0.34–1.17) 0.144
Pa e nal moni‑
o ing
C ude10.60 (0.48–0.75) < 0.001 0.63 (0.49–0.81) < 0.001 0.33 (0.26–0.41) < 0.001 0.86 (0.65–1.14) 0.289 0.46 (0.37–0.57) < 0.001 0.24 (0.18–0.32) <0.001
Adjus eda1 0.60 (0.46–0.76) <0.001 0.65 (0.50–0.85) 0.001 0.34 (0.26–0.43) < 0.001 0.80 (0.59–1.09) 0.154 0.45 (0.35–0.58) <0.001 0.24 (0.17–0.33) < 0.001
Adjus edc1 1.38 (0.94–2.04) 0.103 0.81 (0.55–1.19) 0.285 1.00 (0.67–1.48) 0.997 1.06 (0.68–1.65) 0.785 0.91 (0.63–1.33) 0.639 0.75 (0.45–1.23) 0.255
Family suppo C ude 0.81 (0.76–0.86) < 0.001 0.92 (0.86–0.99) 0.029 0.68 (0.64–0.72) < 0.001 0.85 (0.78–0.92) <0.001 0.70 (0.66–0.75) < 0.001 0.52 (0.48–0.56) <0.001
Adjus eda0.82 (0.77–0.88) <0.001 0.95 (0.88–1.03) 0.240 0.71 (0.67–0.75) <0.001 0.84 (0.77–0.91) < 0.001 0.72 (0.67–0.77) <0.001 0.53 (0.49–0.58) < 0.001
Adjus edb0.97 (0.89–1.07) 0.549 0.94 (0.84–1.05) 0.250 0.89 (0.80–0.98) 0.013 0.92 (0.81–1.04) 0.183 0.85 (0.76–0.94) 0.003 0.76 (0.66–0.87) < 0.001
Pee suppo C ude 0.86 (0.81–0.91) < 0.001 1.07 (0.99–1.15) 0.070 0.84 (0.79–0.88) <0.001 0.94 (0.87–1.01) 0.080 0.89 (0.84–0.95) < 0.001 0.64 (0.60–0.69) < 0.001
Adjus eda0.82 (0.77–0.87) <0.001 1.02 (0.95–1.10) 0.587 0.78 (0.74–0.83) < 0.001 0.88 (0.82–0.96) 0.002 0.85 (0.80–0.91) <0.001 0.61 (0.56–0.66) < 0.001
Adjus edb0.90 (0.82–0.98) 0.019 1.14 (1.02–1.27) 0.017 0.96 (0.87–1.05) 0.333 0.94 (0.84–1.06) 0.321 1.01 (0.92–1.12) 0.783 0.83 (0.73–0.94) 0.004
Teache suppo C ude 0.66 (0.59–0.74) < 0.001 0.69 (0.61–0.78) < 0.001 0.41 (0.37–0.46) < 0.001 0.64 (0.56–0.74) <0.001 0.54 (0.48–0.60) < 0.001 0.31 (0.27–0.36) < 0.001
Adjus eda0.68 (0.60–0.77) <0.001 0.73 (0.64–0.83) <0.001 0.45 (0.40–0.50) < 0.001 0.62 (0.54–0.71) <0.001 0.56 (0.49–0.63) <0.001 0.33 (0.28–0.39) < 0.001
Adjus edb0.94 (0.81–1.09) 0.420 0.89 (0.76–1.05) 0.169 0.73 (0.63–0.85) <0.001 0.65 (0.53–0.79) < 0.001 0.80 (0.67–0.95) 0.011 0.65 (0.51–0.82) < 0.001
Classma e sup‑
po
C ude 0.56 (0.49–0.63) < 0.001 0.64 (0.55–0.74) < 0.001 0.43 (0.38–0.49) <0.001 0.77 (0.67–0.90) <0.001 0.52 (0.46–0.59) < 0.001 0.28 (0.24–0.33) <0.001
Adjus eda0.59 (0.51–0.68) < 0.001 0.69 (0.59–0.80) <0.001 0.50 (0.44–0.58) <0.001 0.79 (0.68–0.93) 0.004 0.55 (0.49–0.63) <0.001 0.33 (0.28–0.40) <0.001
Adjus edb0.86 (0.71–1.03) 0.091 0.81 (0.66–0.99) 0.041 0.97 (0.80–1.18) 0.783 1.10 (0.88–1.38) 0.382 0.87 (0.72–1.05) 0.155 0.80 (0.62–1.04) 0.096
Pe cei ed school
clima e
C ude 0.50 (0.44–0.57) < 0.001 0.62 (0.54–0.72) <0.001 0.33 (0.29–0.37) < 0.001 0.70 (0.61–0.81) < 0.001 0.49 (0.43–0.54) < 0.001 0.26 (0.22–0.30) < 0.001
Adjus eda0.53 (0.46–0.61) <0 .001 0.67 (0.57–0.78) <0.001 0.37 (0.32–0.42) <0.001 0.72 (0.62–0.83) <0.001 0.53 (0.47–0.60) <0.001 0.29 (0.24–0.34) < 0.001
Adjus edb0.72 (0.60–0.85) < 0.001 0.82 (0.67–1.00) 0.052 0.57 (0.47–0.68) < 0.001 0.90 (0.72–1.12) 0.339 0.78 (0.65–0.95) 0.012 0.49 (0.38–0.63) <0.001
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