title: Emotional symptoms among adolescents: epidemiological analysis of individual-, classroom- and school-level factors.
abstract: BACKGROUND
  Large proportions of schoolchildren suffer from emotional symptoms and there are large variations across schools. It is unknown to what degree this variation is due to composition of schoolchildren in each school or to contextual factors. Objectives are to identify factors at individual, classroom and school levels associated with emotional symptoms.
  
  
  METHODS
  Data stem from the Danish contribution to the international Health Behaviour in School-aged Children study 2010 including 4922 schoolchildren aged 11-15-years from a random sample of schools and including data from school leaders. Emotional symptoms are defined as daily presence of at least one of four symptoms: feeling low, irritable or bad tempered, nervous and having difficulties falling asleep. Multilevel multivariable logistic regression analyses are applied to identify and quantify factors at individual, classroom and school level.
  
  
  RESULTS
  Schoolchildren from low (odds ratio (OR) 1.70, 95% CI: 1.33-2.17) and medium (OR 1.50, 95% CI: 1.22-1.85) occupational social class (OSC), girls (OR 1.32, 95% CI: 1.13-1.56) and schoolchildren exposed to bullying (OR 3.82, 95% CI: 2.71-5.40), had increased odds for emotional symptoms. A negative classroom climate was associated with emotional symptoms (OR 1.29, 95% CI: 0.99-1.69) and so was being part of classrooms with a high prevalence of bullying (OR 1.28, 95% CI: 1.0-1.60).
  
  
  CONCLUSIONS
  Female sex, low OSC, single parent family, exposure to bullying and a high prevalence of bullying within a class are all associated with emotional symptoms. Most variation across schools is explained by individual-level factors but psychosocial aspects of the classroom environment also play a role.
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors: Charlotte
authors: C
authors: Meilstrup
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors: Annette K
authors: AK
authors: Ersbøll
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors: Line
authors: L
authors: Nielsen
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors: Vibeke
authors: V
authors: Koushede
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors: Pernille
authors: P
authors: Bendtsen
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors: Pernille
authors: P
authors: Due
authors: National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark bho@niph.dk.
authors: Bjørn E
authors: BE
authors: Holstein
mesh_terms: D000293:Adolescent; D058445:Bullying / Q000706:statistics & numerical data; D003718:Denmark / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012737:Sex Factors; D012959:Socioeconomic Factors