The authors analyze the association between psychosocial factors in the school environment and pupils' health and self-worth in a sample of 538 pupils (264 girls and 274 boys) in the third and the sixth grades. High control in combination with low demand at school was associated with the best health status in relation to somatic problems, stress, tiredness, and feelings of self-worth. In a multiple regression analysis, problems in relations with classmates were the most recurrent psychosocial factor associated with ill-health. Some gender differences were found in school-related health. Lack of control at school affected self-worth among girls only. In the third grade and among boys in the sixth grade, high demands were an explanatory factor for the health outcome. Foreign background, divorced parents, high achievement, and low relational orientation, as well as disorderly and rowdy classes, were also of importance for somatic ill-health and stress among girls. Older girls became more relationally oriented, while boys became more achievement-oriented. The authors conclude that the pupils' somatic health and self-worth were affected by psychosocial factors at school, even when adjustment was made for social background.