Increased municipal spending on school health services is associated with a lower likelihood of severe adolescent distress but does not show a comparable link with students experiencing low school well-being in the absence of psychiatric symptoms, according to an observational study published in BMC Public Health. Researchers Rebecka Persson and Karl Wennberg analyzed survey data spanning nearly two decades to evaluate how municipal financial investments relate to adolescent psychological outcomes across Sweden’s capital region. Addressing an international context of declining youth mental health and rising public investment in school-based support, the authors examined whether local spending benefits all students uniformly or whether its associations diverge across distinct mental health profiles.

Drawing upon biennial data from Stockholmsenkäten, also known as the Stockholm Survey, the researchers compiled an analytic sample of 63,190 ninth-grade students who were approximately 15 years of age across 26 municipalities between 2006 and 2024. Using latent profile analysis, the investigators categorized students into four distinct subgroups: Complete Mental Health, Troubled, Vulnerable, and Symptomatic but Content.

The four identified profiles reflected distinct combinations of internal distress and school-related functioning. Students classified under Complete Mental Health displayed low psychiatric symptoms alongside adequate well-being, whereas the Troubled profile encompassed individuals experiencing both high psychiatric symptoms and low school well-being. Conversely, the Vulnerable profile captured adolescents who reported low levels of psychiatric symptoms yet still suffered from low school well-being. The fourth category, designated as Symptomatic but Content, comprised adolescents who reported elevated psychiatric symptoms while continuing to maintain adequate school well-being. Across the eighteen-year observation period, the proportion of adolescents meeting the criteria for Complete Mental Health declined from 55.6 percent in 2006 to 45.4 percent in 2024, while the prevalence of the Troubled profile more than doubled from 3.4 percent to 7.2 percent, and the Vulnerable group remained stable at approximately 17 percent.

The authors then applied multilevel multinomial logistic regression, nesting individual students within their respective municipalities while adjusting for student gender and survey administration year to estimate associations between spending dynamics and mental health profile membership.

The multilevel regression analysis revealed that within-municipality spending increases were associated with a 16 percent reduction in the odds of students belonging to the Troubled profile, with an odds ratio of 0.84, a 95 percent confidence interval spanning 0.73 to 0.95, and a p-value of .007. In contrast, spending increases showed only a borderline, statistically non-significant association with the Vulnerable profile, yielding an odds ratio of 1.08, a 95 percent confidence interval of 0.99 to 1.17, and a p-value of .084. Furthermore, higher within-municipality spending was associated with a 9 percent increase in the odds of membership in the Symptomatic but Content profile, with an odds ratio of 1.09, a 95 percent confidence interval between 1.01 and 1.17, and a p-value of .026. Differences in average spending between municipalities demonstrated no substantial relationship with profile membership.

The authors suggested that the observed rise in the odds of the Symptomatic but Content profile might reflect a compositional shift away from the Troubled category, occurring when students who retain psychiatric symptoms nonetheless manage to recover adequate school well-being under increased service investments. Overall, the findings indicate that municipal spending successfully reaches adolescents experiencing visible, symptom-driven distress but fails to demonstrate a measurable association for the Vulnerable subgroup, who represent roughly one in six students. From a precision public health perspective, the researchers concluded that school health services may need to expand beyond a predominantly symptom-oriented focus and incorporate systematic attention to school well-being to effectively support vulnerable adolescents.

Subject of Research: Municipal school health spending and adolescent mental health profiles in Sweden

Article Title: Municipal spending on school health services is unequally associated with dual-factor mental health profiles: a latent profile study of 63,000 Swedish adolescents, 2006–2024

Article References: Persson, R., & Wennberg, K. (2026). Municipal spending on school health services is unequally associated with dual-factor mental health profiles: a latent profile study of 63,000 Swedish adolescents, 2006–2024. BMC Public Health, 26(1), Article 3227. https://doi.org/10.1186/s12889-026-30221-2

Image Credits: AI Generated

DOI: 10.1186/s12889-026-30221-2

Keywords: adolescent mental health, school health services, municipal spending, latent profile analysis, dual-factor model, Stockholmsenkäten, precision public health, Sweden, Municipal, spending, school, health