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Mental ill-health in Sweden. Causes and consequences from an inequality perspective.


Summary, in English

The purpose of this thesis is to improve the understanding of factors related to mental ill-health, and its
distribution, in the Swedish population. The thesis consists of four studies. In study I, we find that
between the years 1994 and 2011, the probability of receiving a psychiatric inpatient diagnosis
increased by 12.6 percent, while the relative and absolute income-related inequalities in diagnosis
increased by 48.2 and 66.7 percent, respectively. In fact, in 2011, more than half of psychiatric
inpatients were found among the poorest fifth of the population. Although the population changed
substantially during this period, for example in terms of education level and migration background,
these changes did not drive the increase in inequality. In study II, we show that the labor market
consequences following common mental disorders differ between groups in the population. High-
educated individuals and men have higher odds of non-employment and sick leave compared to lower-
educated individuals and women. Furthermore, individuals with migration backgrounds have higher
odds of non-employment and lower odds of sick leave, compared to individuals born in Sweden. Young
age is moreover associated with higher odds of non-employment and disability pension, and lower
odds of sick leave, following common mental disorders. This heterogeneity suggests that it may be
motivated to consider not only inequalities in the prevalence of mental disorders in the population but
also to regard heterogeneity in the associated adverse labor outcomes in order to curb the burden of
mental ill-health. In study III, we find that over-grading in upper secondary school, that is receiving a
grade that does not reflect one’s actual skills or performance, had a protective impact on mental health
among young women. Further, in study IV, we find that introducing grades in school at an earlier age,
in grade 6 instead of grade 8, increased the probability of mental ill-health among girls. Similar effects
of over-grading and earlier grades were not found among boys and young men. These findings show
that different merits of a grading system have consequences for mental health among girls and young
women, highlighting a potentially important health production mechanism that also may impact health

Publishing year





Lund University, Faculty of Medicine Doctoral Dissertation Series



Document type



Lund University, Faculty of Medicine


  • Health Care Service and Management, Health Policy and Services and Health Economy


  • Mental health
  • Inequality in health
  • Determinants of health
  • Determinants of inequality in health
  • Education policy
  • School grades
  • Grade inflation
  • Grading bias
  • Human capital development



Research group

  • Health Economics


  • ISSN: 1652-8220
  • ISBN: 978-91-8021-379-0

Defence date

31 March 2023

Defence time


Defence place

Agardh föreläsningssal, CRC, Jan Waldenströms gata 35, Skånes Universitetssjukhus i Malmö. Join by Zoom: Password: 594598


  • Helena Svalerud (Professor)