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Chronic health conditions and school experience in school-aged children in 19 European countries

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Abstract

This study investigates chronic conditions (CC) prevalence among children in mainstream schools, their school experience and life satisfaction in Europe. Data were collected from the 2017/2018 HBSC survey, a cross-national study using self-reported questionnaires administered in classrooms. Nationally representative samples of children aged 11, 13, and 15 years in mainstream schools from 19 European countries (n = 104,812) were used. School experience was assessed using four variables: low school satisfaction, schoolwork pressure, low teacher support, and peer-victimization, which were related to life satisfaction. Latent class analysis (LCA) was conducted to identify patterns of school experience among students with CC. The prevalence of CC varied from 8.4 (Armenia) to 28.2% (Finland). Children with CC (n = 17,514) rated their school experience and life satisfaction lower than children without CC. LCA identified three school experience patterns: “negative on all items” (37%), “negative on all items, except school pressure” (40%) and “overall positive” (23%). The distribution of subgroups varied across countries—in countries with a higher proportion of children with CC in mainstream schools, children reported more negative school experiences. Compared to the “overall positive” group, low life satisfaction was highest for students classified as “negative on all items” (relative risk (RR) = 2.9; 95% CI 2.2–3.8) with a lesser effect for “negative on all items, except school pressure” (RR) = 1.8; 95% CI 1.4–2.4). These findings provide cross-national data documenting the diversity in inclusive educational practices regarding school placement and school experiences, and suggest that efforts are still needed to allow a fully inclusive environment.

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Data availability

Mariane Sentenac had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Acknowledgements

We thank Jennifer Zeitlin, DSc, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRAE, Université de Paris Cité, Paris, France, for her helpful comments on the draft manuscript. HBSC is an international study carried out in collaboration with WHO/EURO. The International Coordinator of the 2017/2018 survey was Jo Inchley (University of Glasgow) and the Data Bank Manager was Oddrun Samdal (University of Bergen). The present study used data from 19 countries/regions in the 2017/2018 survey, conducted by the following principal investigators: Sergey Sargsyan and Marina Melkumova (Armenia), Rosemarie Felder-Puig (Austria), Gahraman Hagverdiyev (Azerbaijan), Lidiya Vasileva (Bulgaria), Michal Kalman (Czech Republic), Mette Rasmussen (Denmark), Fiona Brooks and Ellen Klemera (England), Jorma Tynjälä (Finland), Emmanuelle Godeau (France), Lela Shengelia (Georgia), Ágnes Németh (Hungary), Saoirse Nic Gabhainn (Ireland), Lina Kjostarova Unkovska (North Macedonia), Joanna Mazur and Agnieszka Malkowska-Szkutnik (Poland), Galina Lesco (Republic of Moldova), Jo Inchley (Scotland), Petra Lofstedt (Sweden), and Chris Roberts (Wales). For details, see http://www.hbsc.org.

Funding

There is no specific support obtained for this study.

Author information

Authors and Affiliations

  1. Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRAE, Université de Paris Cité, Paris, France

    Mariane Sentenac

  2. Universidade Europeia, Lisbon, Portugal

    Teresa Santos

  3. Centro de Investigação Interdisciplinar Em Saúde (CIIS), Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Lisbon, Portugal

    Teresa Santos

  4. CHILD, School of Learning and Communication, Jönköping University, Jönköping, Sweden

    Lilly Augustine

  5. National Institute of Public Health, University of Southern, Copenhagen, Denmark

    Susan I. Michelsen

  6. Arabkir Medical Center-Institute of Child and Adolescent Health, Yerevan, Armenia

    Yeva Movsesyan

  7. School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland

    Kwok Ng

  8. Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland

    Kwok Ng

  9. Faculty of Education, University of Warsaw, Warsaw, Poland

    Agnieszka Małkowska-Szkutnik

  10. French School of Public Health, EHESP, Rennes, France

    Emmanuelle Godeau

  11. CERPOP-UMR1295, UMR INSERM-Université Toulouse III Paul Sabatier–Team SPHERE, Toulouse, France

    Emmanuelle Godeau

Authors
  1. Mariane Sentenac
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  2. Teresa Santos
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  3. Lilly Augustine
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  4. Susan I. Michelsen
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  5. Yeva Movsesyan
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  6. Kwok Ng
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  7. Agnieszka Małkowska-Szkutnik
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  8. Emmanuelle Godeau
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Contributions

DrMS conceptualized and designed the study, performed the analysis of data, drafted the initial manuscript, and reviewed and revised the manuscript. DrTS and DrEG conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. DrLA, DrSIM, DrYM, DrKNg, and DrAMS contributed to the interpretation of the drafted the manuscript, and provided critical revision of the manuscript. All the authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Mariane Sentenac.

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The authors have no conflicts of interest relevant to this article to disclose.

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Supplementary file1 (DOCX 104 KB)

Appendix A: Cleaning and coding of self-reported CC data in the HBSC

Appendix A: Cleaning and coding of self-reported CC data in the HBSC

Variables

CC2: long-term illness, disability, or medical condition (yes = 1; no = 2).

CC4: School attendance and participation restricted due to CC (do not have CC = 1; CC with restriction = 2; CC without restriction = 3)—in Sweden, response options were: CC with restriction = 2; CC without restriction = 3.

CC2_corr: corrected variable for CC2 (yes = 1; no = 2).

CC4_corr: corrected variable for CC4 (do not have CC = 1; CC with restriction = 2; CC without restriction = 3).

Three steps

Step 1—If CC2 = “No” and CC4 = “CC without restriction”, it was assumed that the respondent do not have CC (> > CC4_corr = “Do not have CC”).

Step 2—Coding of missing data on CC2 and CC4.

  • If CC2 is missing and CC4 = “Do not have CC”, it was assumed that the respondent do not have CC (> > CC2_corr = “No”)

  • If CC2 is missing and CC4 = “CC with restriction”, it was assumed that the respondent have CC (> > CC2_corr = “Yes”)

  • If CC2 = ”No” and CC4 is missing, it was assumed that the respondent do not have CC (CC4_corr = “Do not have CC”)

    Step 3—Coding of inconsistencies between CC2 and CC4 into missing data.

  • If CC2 = “Yes” and CC4 = “Do not have CC”, CC4_corr was coded as missing

  • If CC2 = “No” and CC4 = “CC with restrictions”, CC2_corr and CC4_corr were coded as missing

    Specific coding applied to Finland and Sweden.

  • In Finland, CC4 was missing when CC2 = “No”. Therefore, if CC2 = “No” and region = “Finland”, CC4_corr was coded as “Do not have CC”

  • Given that the response option “Do not have CC = 1” was not provided in Sweden, CC4_corr was coded as “Do not have CC” when CC2 = “No” and region = “Sweden”

STATA syntax

*/Corrected variables.

gen CC2_corr = CC2.

gen CC4_corr = CC4.

*/Step 1.

replace CC4_corr = 1 if CC2 =  = 2 & CC4 =  = 3.

*/Step 2: Coding of missing data on CC2 and CC4.

replace CC2_corr = 2 if CC2 =  = . & CC4 =  = 1.

replace CC2_corr = 1 if CC2 =  = . & CC4 =  = 2.

replace CC4_corr = 1 if CC2 =  = 2 & CC4 =  = .

*/Step 3: Coding of inconsistencies between CC2 and CC4 into missing data.

replace CC4_corr = . if CC2 =  = 1 & CC4 =  = 1.

replace CC2_corr = . if CC2_corr =  = 2 & CC4_corr =  = 2.

replace CC4_corr = . if CC2_corr =  = 2 & CC4_corr =  = 2.

*/Specific coding applied to Finland and Sweden.

*For Sweden,

replace CC4_corr = 1 if CC2_corr =  = 2 & region =  = "SE".

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Sentenac, M., Santos, T., Augustine, L. et al. Chronic health conditions and school experience in school-aged children in 19 European countries. Eur Child Adolesc Psychiatry 32, 1711–1721 (2023). https://doi.org/10.1007/s00787-022-01987-8

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