title: Do changes in the psychosocial school environment influence pupils' health development? Results from a three-year follow-up study.
abstract: OBJECTIVE
  This study analysed the effects of psychosocial factors at school on pupils' health and self-worth from a longitudinal perspective.
  
  
  METHODS
  A three-year prospective study was started in 1994, including 533 pupils (261 girls, 272 boys) from 25 different classes in grades 3 and 6. With age-adjusted questionnaires the changes in self-perceived health were compared with changes in psychosocial school environmental factors.
  
  
  RESULTS
  The girls in the older cohort reported a negative health development with decreased self-worth and increased somatic and psychological symptoms. Significant gender differences in ill health, but not in self-worth, developed, especially in the older cohort. A multiple regression analysis showed that a negative development of psychosocial factors at school, measured as control, demand, and classmate problems, was associated with poorer health and self-worth among the pupils. A trichotomization of the psychosocial variables at school indicated a possible causal relationship between psychosocial factors and ill health and self-worth.
  
  
  CONCLUSIONS
  The negative development in pupils' health and self-worth could partly be explained by the more unfavourable psychosocial environment that prevails at school at the senior level. The public health implications of our study can be summarized as the need for schools to improve pupils' social situation at school in relation to their work situation as well as to pay special attention to the school situation of girls at senior level.
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. katja.gillander-gadin@mh.se
authors.forename: Katja Gillander
authors.initials: KG
authors.lastname: Gådin
authors.forename: Anne
authors.initials: A
authors.lastname: Hammarström
mesh_terms: D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012649:Self Concept; D012737:Sex Factors; D012931:Social Environment; D013334:Students / Q000523:psychology*; D013997:Time Factors