Factors affecting the spread of mental health problems in schools

Diagnoses for psychiatric disorders such as ADHD and various depressive disorders are steadily climbing in Sweden and other developed nations. This is particularly worrisome in populations of school children, where diagnoses of psychiatric disorders are at an all-time high.

In response to this trend, the Swedish government has set up a task force for investigating the ways to improve the mental health of Swedish youth. PSYNK (psykisk hälsa, barn och unga) is a project under the auspices of SKL, an organization representing the interests of Swedish local and municipal governments.

Two of the PSYNK project’s main goals are to identify some of the factors responsible for the rise in psychiatric disorders in the schools and to find specific ways that the spread of these disorders can be counteracted by targeted action from governments on the local level.

In cooperation with PSYNK, the Institute for Futures Studies is working on developing and testing a mathematical model that identifies the key factors that contribute to the spread of disorders within classrooms and between students. We study students in the 9th grade.

Psychiatric disorders such as ADHD and depression, as well as behavioral problems such as drug and alcohol use, can be transmitted through social interactions within a classroom.

There is a lot of evidence in the literature that psychiatric disorders such as ADHD and depression, as well as behavioral problems such as drug and alcohol use, can be transmitted through social interactions within a classroom (1). A number of factors are associated with each of these problems, including genetic and biological, psychiatric, cultural and socioeconomic. In our modeling, we study the effects of cultural factors as manifested by the overall quality of the student’s school environment and the effects of socioeconomic factors as manifested by the student's social and economic background. We chose these particular factors because they are the ones that can be most easily influenced by outside intervention and are thus the most promising candidates for improving the efficiency with which mental health problems are treated in the schools.

The above figure shows how the proportion of class population affected by a particular disorder changes as the proportion of students who are already affected increases. It tells us that there is a tipping Point (where the dotted line is crossed the first time), past which it becomes increasingly difficult to curtail the spread of a particular disorder in the population.

From this figure, you can see that a slight improvement in the quality of home life (meaning social and economic factors) is not necessarily sufficient for improving the situation. Instead, a threshold effect is observed, where only raising the quality of home life above a particular threshold level will lead to a decrease in the proportion of affected students.

This nonlinear effect tells us that a simple investment of X SEK into home life improvement will not necessarily lead to an X % improvement in problem levels. Instead, at levels of home quality close to the threshold, a small investment can yield great positive results. At the same time, at levels of home quality far below the threshold, a great investment in home quality is needed to improve the situation even slightly.

We hope to make it possible for local governments in Sweden to easily identify where the most help is needed

We are currently in the process of validating the model using data on school quality (from Skolverket) and socioeconomic background (from SCB). What we hope to accomplish is to identify which of the many socioeconomic and school-related factors have the greatest effect on the likelihood of a student developing a particular disorder. Also, we hope to identify risk factors and warning signs for schools and communities that are on the verge of going past the tipping point and experiencing a wave of psychiatric and behavioral problems in their classrooms. Finally, we hope to make it possible for local governments in Sweden to easily identify where the most help is needed, and where a little bit of action right now can make a huge difference down the road.

(1) Hawton et al. 2012, Zentall et al. 2011

References:
Dohrenwend BP, Levav I, Shrout P et al (1992) Socioeconomic status and psychiatric disorders: the causation-selection issue Science 255:946-952
Hawton K, Saunders KEA, O’Connor RC (2012) Self-harm and suicide in adolescents Lancet 379:2373-2382
Statens Folkhälsoinstitut (2009) Kartläggning av barns och ungdomars psykiska hälsa skolor årskurs 9
Sveriges Socialstyrelse (2012) Skolans betydelse för barns och ungas psykiska hälsa
Zentall SS, Craig BA, Kuester DA (2011) Social behaviour in cooperative groups: students at risk for ADHD and their peers The Journal of Educational Research 104:28-41

 by Boris Granovskiy