Article Text

Download PDFPDF
Is perceived failure in school performance a trigger of physical injury? A case-crossover study of children in Stockholm County
  1. L Laflamme,
  2. K Engström,
  3. J Möller,
  4. J Hallqvist
  1. Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, Sweden
  1. Correspondence to:
 Dr L Laflamme
 Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, SE-171 76 Stockholm, Sweden;


Objectives: To investigate whether perceived failure in school performance increases the potential for children to be physically injured.

Subjects: Children aged 10–15 years residing in the Stockholm County and hospitalised or called back for a medical check up because of a physical injury during the school years 2000–2001 and 2001–2002 (n = 592).

Methods: A case-crossover design was used and information on potential injury triggers was gathered by interview. Information about family socioeconomic circumstances was gathered by a questionnaire filled in by parents during the child interview (response rate 87%).

Results: Perceived failure in school performance has the potential to trigger injury within up to 10 hours subsequent to exposure (relative risk = 2.70; 95% confidence intervals = 1.2 to 5.8). The risk is significantly higher among pre-adolescents and among children from families at a higher education level.

Conclusions: Experiencing feelings of failure may affect children’s physical safety, in particular among pre-adolescents. Possible mechanisms are perceptual deficits and response changes occasioned by the stress experienced after exposure.

  • injury mechanism
  • case-crossover design
  • injury trigger
  • academic performance
  • socioeconomic position

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: the project was co-financed by the Swedish Council for Working Life and Social Research, Sweden’s National Institute of Public Health, and Stockholm County Council.

  • Conflicts of interest: none declared.

Linked Articles