Changes in self-rated health of Finnish adolescents from 1981 to 2023

Abstract Background A decline in adolescents’ mental wellbeing has been reported in many countries. If the COVID-19 pandemic is not counted, the roots for the decline are poorly known. Some studies have suggested that the decline started already before the pandemic. We study changes in Finnish adolescents’ low self-rated health (SRH) and its relation to socio-demographic and school factors in 1981-2023. Methods Two nationwide surveys of 14-year-olds, Adolescent Health and Lifestyle Survey (1981-2019) and School Health Promotion Study (2000-2023) measured SRH (“would you say your health is: very good, fairly good, average, fairly bad, very bad”). Explanatory variables were survey year, sociodemographic risks (gender, parents’ low education, parents’ not living together, parents’ smoking) and school-related risks (poor relationship with teachers, poor classroom atmosphere, learning difficulties, poorer performance). The data were analyzed using logistic regression modelling. Results Between 1981 and 2015 the proportion of those with low SRH stayed stable; gender differences were small (boys 15%, girls 18%). The increase started in 2015 among girls only (35% in 2023). All risk factors studied explained low SRH but could explain one-tenth of the change. The association of low SRH with parents’ low education and learning difficulties strengthened over the years among both genders, and among boys with parental smoking, poor class atmosphere and problems in relationship with teachers. Conclusions Regardless of many societal changes, boys’ SRH has stayed steady, while girls’ perceptions of their health have declined in recent years. Further study is needed to discover the mechanisms, particularly the increasing risk of low SRH among those with learning difficulties. Key messages • Regardless of many societal changes, adolescents’ SRH stayed steady until 2015. From 2015 onwards, SRH decreased, but only among girls. • All risk factors studied in family and school environment explained low SRH but could explain one-tenth of the change.