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  • 1.
    Akbaraly, Tasmine
    et al.
    PSL Res Univ, Univ Montpellier, MMDN, EPHE, INSERM, U1198, Montpellier, France; UCL, Dept Epidemiol & Publ Hlth, London, England; Hosp & Univ Res Ctr Montpellier, Dept Psychiat, Montpellier, France; Hosp & Univ Res Ctr Montpellier, Autism Resources Ctr, Montpellier, France.
    Sexton, Claire
    Univ Oxford, FMRIB Ctr, Nuffield Dept Clin Neurosci, Oxford, England.
    Zsoldos, Eniko
    Univ Oxford, Dept Psychiat, Neurobiol Ageing Grp, Oxford, England.
    Mahmood, Abda
    Univ Oxford, Dept Psychiat, Neurobiol Ageing Grp, Oxford, England.
    Filippini, Nicola
    Univ Oxford, Dept Psychiat, Neurobiol Ageing Grp, Oxford, England.
    Kerleau, Clarisse
    PSL Res Univ, Univ Montpellier, MMDN, EPHE, INSERM, U1198, Montpellier, France.
    Verdier, Jean-Michel
    PSL Res Univ, Univ Montpellier, MMDN, EPHE, INSERM, U1198, Montpellier, France.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Gabelle, Audrey
    Univ Montpellier, Memory Resources & Res Ctr Alzheimers Dis & Relat, Dept Neurol, Gui de Chauliac Hosp, INSERM, U1183, Montpellier, France.
    Ebmeier, Klaus
    Univ Oxford, Dept Psychiat, Neurobiol Ageing Grp, Oxford, England.
    Kivimäki, Mika
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Association of Long-Term Diet Quality with Hippocampal Volume: Longitudinal Cohort Study2018In: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 131, no 11, p. 1372-1381.e4Article in journal (Refereed)
    Abstract [en]

    Background: Diet quality is associated with brain aging outcomes. However, few studies have explored in humans the brain structures potentially affected by long-term diet quality. We examined whether cumulative average of the Alternative Healthy Eating Index 2010 (AHEI-2010) score during adult life (an 11-year exposure period) is associated with hippocampal volume.

    Methods: Analyses were based on data from 459 participants of the Whitehall II imaging sub-study (mean age [standard deviation] (SD) = 59.6 [5.3] years in 2002-2004, 19.2% women). Multimodal magnetic resonance imaging examination was performed at the end of follow-up (2015-2016). Structural images were acquired using a high-resolution 3-dimensional T1-weighted sequence and processed with Functional Magnetic Resonance Imaging of the Brain Software Library (FSL) tools. An automated model-based segmentation and registration tool was applied to extract hippocampal volumes.

    Results: Higher AHEI-2010 cumulative average score (reflecting long-term healthy diet quality) was associated with a larger total hippocampal volume. For each 1 SD (SD = 8.7 points) increment in AHEI-2010 score, an increase of 92.5 mm3 (standard error = 42.0 mm3) in total hippocampal volume was observed. This association was independent of sociodemographic factors, smoking habits, physical activity, cardiometabolic health factors, cognitive impairment, and depressive symptoms, and was more pronounced in the left hippocampus than in the right hippocampus. Of the AHEI-2010 components, no or light alcohol consumption was independently associated with larger hippocampal volume.

    Conclusions: Higher long-term AHEI-2010 scores were associated with larger hippocampal volume. Accounting for the importance of hippocampal structures in several neuropsychiatric diseases, our findings reaffirm the need to consider adherence to healthy dietary recommendation in multi-interventional programs to promote healthy brain aging.

  • 2.
    Almquist, Ylva B.
    et al.
    Stockholm Univ, Karolinska Inst, Stockholm, Sweden..
    Landstedt, E.
    Stockholm Univ, Karolinska Inst, Umea, Sweden..
    Jackisch, J.
    Stockholm Univ, Karolinska Inst, Stockholm, Sweden..
    Rajaleid, K.
    Stockholm Univ, Karolinska Inst, Stockholm, Sweden..
    Westerlund, H.
    Stockholm Univ, Karolinska Inst, Stockholm, Sweden..
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Growing through asphalt: What counteracts the long-term negative health impact of youth adversity?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27Article in journal (Other academic)
  • 3.
    Almquist, Ylva B.
    et al.
    Stockholm Univ, Dept Publ Hlth Sci, Ctr Hlth Equ Studies CHESS, Stockholm, Sweden.
    Landstedt, Evelina
    Umeå Univ, Norrland Univ Hosp, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, Umeå, Sweden.
    Jackisch, Josephine
    Stockholm Univ, Dept Publ Hlth Sci, Ctr Hlth Equ Studies CHESS, Stockholm, Sweden.
    Rajaleid, Kristiina
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Prevailing over Adversity: Factors Counteracting the Long-Term Negative Health Influences of Social and Material Disadvantages in Youth2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 9, article id 1842Article in journal (Refereed)
    Abstract [en]

    Disadvantaged circumstances in youth tend to translate into poor health development. However, the fact that this is not always the case has been seen as indicative of differential resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status. This study was based on two waves of questionnaire data from the Northern Swedish Cohort. From the wave in 1981 (age 16), indicators of social and material conditions as well as factors related to school, peers, and spare time were derived. From the wave in 2008 (age 43), information about self-rated health was used. Ordinal logistic regression models (n = 908) showed that adversity in youth was associated with poorer self-rated health in midlife among men and women alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health. This suggests that health-promoting interventions may benefit from focusing on contexts outside the family in their effort to strengthen processes of resilience among disadvantaged youths.

  • 4.
    Aronsson, G
    et al.
    Stockholm University.
    Theorell, T
    Stockholm University.
    Grape, T
    Stockholm University.
    Hammarström, A
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Hogstedt, C
    Karolinska Institute.
    Martinsdottir, I
    Linköping University.
    Skoog, I
    Göteborg University.
    Träskman-Bendz, L
    Lund University.
    Hall, C
    Karolinska Institute.
    A systematic review including meta-analysis of work environment andburnout symptoms2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, no 1Article in journal (Refereed)
  • 5.
    Bean, Christopher
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. School of Psychology, University of Adelaide, Australia.
    Pingel, Ronnie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    A 4-way decomposition analysis of poor social relations and depressive symptoms over the life-course2017In: European Journal of Public Health, Volume 27, Issue Suppl 3, 2017Conference paper (Refereed)
  • 6.
    Bean, Christopher
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Pingel, Ronnie
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Poor peer relations in adolescence, social support in early adulthood and depressive symptoms in later adulthood. Evaluating mediation and interaction using four-way decomposition analysis2019In: Annals of Epidemiology, ISSN 1047-2797, E-ISSN 1873-2585, Vol. 29, no 1, p. 52-59Article in journal (Refereed)
    Abstract [en]

    Purpose: Supportive social relations are associated with good mental health, yet few studies have considered the prospective importance of adolescent peer relations for adult mental health and the potential mechanisms involved.

    Methods: Participants (n=941) were sourced from the Northern Swedish Cohort, a prospective study comprising school students aged 16 in 1981. Integrating life course epidemiology with four-way decomposition analysis, this paper considers the controlled direct effect of poor peer relations at age 16 on depressive symptoms at age 43, the pure indirect effect mediated by the availability of social support at age 30, and potential interactions between the exposure and the mediator.

    Results: After controlling for gender, baseline depressive symptoms and parental socioeconomic position, poor peer relations at age 16 were associated with depressive symptoms at age 43, largely irrespective of social support at age 30. Nonetheless, poor peer relations in adolescence were associated with poorer social support at age 30, and mediation accounted for a modest proportion (pure indirect effect 10%) of the association between poor peer relations and depressive symptoms at age 43.

    Conclusions: Policies to foster constructive peer relations for adolescents at school are encouraged; such policies may promote both the availability of social support and better mental health across the life course.

  • 7.
    Bean, Christopher
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Westerlund, Hugo
    Stockholm University.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Group activity participation at age 21 and depressive symptoms during boom and recession in Sweden:: a 20-year follow-up2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360XArticle in journal (Refereed)
    Abstract [en]

    Background: Organized group activities (e.g. sports or arts clubs) have long been noted as important developmental settings for youth, yet previous studies on the relationships between participation and mental health outcomes have focused on short-term effects among school-aged adolescents. The subsequent period of life, emerging adulthood, has been largely overlooked despite being another important life stage where individuals face new existential challenges and may benefit from group activity participation. The potential for macroeconomic conditions to modify these relationships has also not been considered.

    Methods: Participants (n = 1654) comprise two cohorts, born in either 1965 (n = 968) or 1973 (n = 686), from the same middle-sized industrial town in Northern Sweden. Both cohorts completed detailed questionnaires at age 21 (macroeconomic boom for Cohort 65, recession for Cohort 73) and approximately 20 years follow-up (age 43 for Cohort 65, age 39 for Cohort 73). General linear models were used to assess concurrent and prospective associations between regular group activity participation and depressive symptoms, as well as the potential interaction with boom/recession.

    Results: After controlling for sociodemographic factors, regular group activity participation at age 21 was associated with lower depressive symptoms, both concurrently and at follow-up. Those exposed to recession at age 21 reported higher depressive symptoms at the time but there was no interaction between cohort (boom/recession) and group activity participation.

    Conclusions: Regular group activity participation during emerging adulthood is associated with lower depressive symptoms uniformly in times of boom and recession. Beneficial effects of such participation may contribute to better mental health over 20 years.

  • 8.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Huono-osaisuuden kasautuminen nuoruusiästä keski-ikään.: Lectio praecursoria2017In: Sosiaalilääketieteellinen aikakauslehti, ISSN 0355-5097, Vol. 54, no 2, p. 159-164Article in journal (Other academic)
  • 9.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Al-Janabi, Thair
    National Institute for Health and Welfare.
    Santalahti, Päivi
    National Institute for Health and Welfare.
    Kuinka tukea terveydenhuollon ammattilaisia, jotka ovat turvapaikanhakijoina tai pakolaisina Suomessa?2017In: Journal of Social Medicine, ISSN 0355-5097, Vol. 54, no 3, p. 244-246Article in journal (Other (popular science, discussion, etc.))
  • 10.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. National Institute for Health and Welfare, Finland.
    Huurre, Taina
    Kiviruusu, Olli
    Aro, Hillevi
    Nuoruusiän huono-osaisuus ja sen kasautumisen yhteys kuolleisuuteen. Seurantatutkimus 16-vuotiaista nuorista2011In: Sosiaalilääketieteellinen Aikakauslehti, Vol. 48, no 3, p. 168-181Article in journal (Refereed)
  • 11.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. National Institute for Health and Welfare, Helsinki, Finland.
    Kiviruusu, Olli
    National Insitute for Health and Welfare, Helsinki, Finland.
    Bean, Christopher
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Huurre, Taina
    National Institute for Health and Welfare, Helsinki, Finland.
    Lintonen, Tomi
    Finnish Foundation for Alcohol studies, Helsinki, Finland.; University of Tampere, Tampere, Finland.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Social relationships in adolescence and heavy episodic drinking from youth to midlife in Finland and Sweden: examining the role of individual, contextual and temporal factors2018In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 1000Article in journal (Refereed)
    Abstract [en]

    Background

    Applying the Process-Person-Context-Time (PPCT) model of the bioecological theory, this study considers whether proximal processes between the individual and the microsystem (social relationships within family, peer group and school) during adolescence are associated with heavy episodic drinking (HED), from youth to midlife, and whether the macro level context (country) plays a role in these associations.

    Methods

    Participants of two prospective cohort studies from Finland and Sweden, recruited in 1983/1981 at age 16 (n = 2194/1080), were followed-up until their forties using postal questionnaires. Logistic regression analysis was used to examine associations between social relationships at age 16 and HED (at least monthly intoxication or having six or more units of alcohol in one occasion) at ages 22/21, 32/30 and 42/43. Additive interactions between microsystem settings, as well as between settings and country, were also considered.

    Results

    Consistent with the PPCT model, we found individual, contextual and temporal aspects to be associated with drinking habits. Higher levels of poor family relationships were associated with an increased likelihood of HED (ages 22/21 and 32/30) in both Finnish women and men and Swedish men. Higher levels of peer contact were associated with an increased likelihood of HED in both Finnish women (ages 32 and 42) and men (ages 22 and 32), and Swedish men (age 21). In contrast with the other groups, poorer relationships with classmates were associated with an increased likelihood of HED (age 30) for Swedish women only. For women, the combined effect of having both daily peer contact and living in Finland for HED at age 42/43 was statistically distinguishable from a pure additive effect.

    Conclusions

    Micro and to a lesser extent macro level contexts are associated with heavy episodic drinking well into adulthood. The most relevant processes in the adolescent microsystem occur in family and peer settings. However, long-lasting protective or risk-raising effects between different settings and later HED were not found. Promoting good relationships across different contexts during adolescence may reduce the incidence of HED in adulthood.

  • 12.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
    Kiviruusu, Olli
    Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
    Huurre, Taina
    Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.;Department of Health and Social Welfare, City of Vantaa, Vantaa, Finland.
    Lintonen, Tomi
    Finnish Foundation for Alcohol Studies, Helsinki, Finland.;Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland.
    Virtanen, Pekka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Associations between unemployment and heavy episodic drinking from adolescence to midlife in Sweden and Finland2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 2, p. 258-263Article in journal (Refereed)
    Abstract [en]

    Background

    Unemployment and alcohol use have often been found to correlate and to act as risk factors for each other. However, only few studies have examined these associations at longitudinal settings extending over several life phases. Moreover, previous studies have mostly used total consumption or medical diagnoses as the indicator, whereas subclinical measures of harmful alcohol use, such as heavy episodic drinking (HED), have been used rarely. The aim of this study was to examine the associations between HED and unemployment from adolescence to midlife in two Nordic countries.

    Methods

    Participants of separate cohort studies from Sweden and Finland were recruited at age 16 in 1981/1983 and followed up at ages 21/22, 30/32 and 43/42, (n = 1080/2194), respectively. Cross-lagged autoregressive models were used to determine associations between HED and unemployment.

    Results

    In the Swedish cohort, HED at ages 16 and 30 in men and HED at age 21 in women were associated with subsequent unemployment. In the Finnish cohort, we found corresponding associations at age 16 in women and at age 22 in men. However, the gender differences were not statistically significant. The associations from unemployment to HED were non-significant in both genders, in both cohorts and at all ages.

    Conclusions

    Our results suggest that heavy drinkers are more likely to experience unemployment in subsequent years. The associations from HED to unemployment seem to exist through the life course from adolescence to midlife. More emphasis should be put on reducing alcohol related harms in order to improve labour-market outcomes.

  • 13.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. National Institute for Health and Welfare, Finland.
    Kiviruusu, Olli
    National Institute for Health and Welfare, Finland.
    Huurre, Taina
    National Institute for Health and Welfare, Finland.
    Lintonen, Tomi
    Finnish Foundation for Alcohol Research.
    Virtanen, Pekka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. University of Tampere.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Unemployment and heavy episodic drinking from adolescence to midlife in Sweden and Finland2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl. 3Article in journal (Other academic)
  • 14.
    Brydsten, A
    et al.
    Umeå University.
    Gustafsson, P
    Umeå University.
    Hammarström, A
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    San Sebastian, M
    Umeå University.
    Does contextual unemployment matter for health status across the lifecourse? A longitudinal multilevel study exploring the link between neighbourhoodunemployment and functional somatic symptoms.2017In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 43, p. 113-120Article in journal (Refereed)
  • 15.
    Brydsten, Anna
    et al.
    Stockholm Univ, Dept Publ Hlth Sci, SE-10691 Stockholm, Sweden.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    San Sebastian, Miguel
    Umea Univ, Dept Publ Hlth & Clin Med, Epidemiol & Global Hlth Unit, SE-90185 Umea, Sweden.
    Health inequalities between employed and unemployed in northern Sweden: a decomposition analysis of social determinants for mental health2018In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 59Article in journal (Refereed)
    Abstract [en]

    Background: Even though population health is strongly influenced by employment and working conditions, public health research has to a lesser extent explored the social determinants of health inequalities between people in different positions on the labour market, and whether these social determinants vary across the life course. This study analyses mental health inequalities between unemployed and employed in three age groups (youth, adulthood and mid-life), and identifies the extent to which social determinants explain the mental health gap between employed and unemployed in northern Sweden. Methods: The Health on Equal Terms survey of 2014 was used, with self-reported employment (unemployed or employed) as exposure and the General Health Questionnaire (GHQ-12) as mental health outcome. The social determinants of health inequalities were grouped into four dimensions: socioeconomic status, economic resources, social network and trust in institutional systems. The non-linear Oaxaca decomposition analysis was applied, stratified by gender and age groups. Results: Mental health inequality was found in all age groups among women and men (difference in GHQ varying between 0.12 and 0.20). The decomposition analysis showed that the social determinants included in the model accounted for 43-51% of the inequalities among youths, 42-98% of the inequalities among adults and 60-65% among middle-aged. The main contributing factors were shown to vary between age groups: cash margin (among youths and middle-aged men), financial strain (among adults and middle-aged women), income (among men in adulthood), along with trust in others (all age groups), practical support (young women) and social support (middle-aged men); stressing how the social determinants of health inequalities vary across the life course. Conclusions: The health gap between employed and unemployed was explained by the difference in access to economic and social resources, and to a smaller extent in the trust in the institutional systems. Findings from this study corroborate that much of the mental health inequality in the Swedish labour market is socially and politically produced and potentially avoidable. Greater attention from researchers, policy makers on unemployment and public health should be devoted to the social and economic deprivation of unemployment from a life course perspective to prevent mental health inequality.

  • 16.
    Brydsten, Anna
    et al.
    Umeå universitet, Epidemiologi och global hälsa.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Epidemiologi och global hälsa.
    San Sebastian, Miguel
    Umeå universitet, Epidemiologi och global hälsa.
    The impact of economic recession on the association between youth unemployment and functional somatic symptoms in adulthood: a difference-in-difference analysis from Sweden2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 230Article in journal (Refereed)
    Abstract [en]

    Background: The impact of macroeconomic conditions on health has been extensively explored, as well as the relationship between individual unemployment and health. There are, however, few studies taking both aspects into account and even fewer studies looking at the relationship in a life course perspective. In this study the aim was to assess the role of macroeconomic conditions, such as national unemployment level, for the long-term relationship between individual unemployment and functional somatic symptoms (FSS), by analysing data from two longitudinal cohorts representing different periods of unemployment level in Sweden.

    Methods: A difference-in-difference (DiD) analysis was applied, looking at the difference over time between recession and pre-recession periods for unemployed youths (age 21 to 25) on FSS in adulthood. FSS was constructed as an index of ten self-reported items of somatic ill-health. Covariates for socioeconomics, previous health status and social environment were included.

    Results: An association was found in the difference of adult FSS between unemployed and employed youths in the pre-recession and recession periods, remaining in the adjusted model for the pre-recession period. The DiD analysis between unemployed youths showed that men had significantly lower adult FSS during the recession compared to men in the pre-recession time.

    Conclusions: Adulthood FSS showed to be significantly lower among unemployed youths, in particular among men, during recession compared to pre-recession times. Since this is a fairly unexplored research field, more research is needed to explore the role of macroeconomic conditions for various health outcomes, long-term implications and gender differences.

  • 17.
    Brydsten, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Hammarström, Anne
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Strandh, Mattias
    Umeå universitet, Institutionen för socialt arbete.
    Johansson, Klara
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Youth unemployment and functional somatic symptoms in adulthood: results from the Northern Swedish cohort2015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 5, p. 796-800Article in journal (Refereed)
    Abstract [en]

    Background: Little is known about the possible long-term health consequences of youth unemployment. Research indicates that unemployment may lead to socioeconomic downward mobility and mental health problems, but we still lack knowledge of the long-term health consequences of youth unemployment. This article examines the potential long-term association between youth unemployment and functional somatic symptoms in adulthood. 

    Methods: The ‘Northern Swedish cohort’ was used with data from five data collections, from 1981 (age 16) until 2007 (age 42). Youth unemployment was measured as months in unemployment between age 16 and 21, and health outcome as functional somatic symptoms (an index of 10 items of self-reported symptoms). Linear regression was used to analyse the relationship between months in youth unemployment and functional somatic symptoms at age 21 and age 42, stratified for women and men and adjusted for potential confounders, such as time spent in education at age 21 and later unemployment between age 21 and 42. 

    Results: Youth unemployment was significantly related to functional somatic symptoms at age 21 for men after controlling for confounders, but not for women. Among men, the association remained for functional somatic symptoms at age 42, after controlling for confounders. 

    Conclusions: Adolescence seems to be a sensitive period during which unemployment could have remaining health effects in adulthood, at least for men, though assumptions of causality are tentative and more research is needed.

  • 18.
    Byhamre, Marja Lisa
    et al.
    Umea Univ, Dept Publ Hlth & Clin Med, Family Med, SE-90185 Umea, Sweden..
    Gustafsson, Per E.
    Umea Univ, Dept Publ Hlth & Clin Med, Epidemiol & Global Hlth, Umea, Sweden..
    Jansson, Jan-Håkan
    Umea Univ, Dept Publ Hlth & Clin Med, Skelleftea Res Unit, Umea, Sweden..
    Wennberg, Maria
    Umea Univ, Dept Publ Hlth & Clin Med, Nutr Res, Umea, Sweden..
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Wennberg, Patrik
    Umea Univ, Dept Publ Hlth & Clin Med, Family Med, SE-90185 Umea, Sweden..
    Snus use during the life-course and risk of the metabolic syndrome and its components2017In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 8, p. 733-740Article in journal (Refereed)
    Abstract [en]

    Objective: We aimed to investigate the association between life-course exposure to snus and prevalence of the metabolic syndrome and its components in adulthood.

    Design and method: Tobacco habits at baseline (age 16) and three follow-ups (ages 21, 30 and 43) were assessed among 880 participants in a population-based cohort in Northern Sweden. Presence of the metabolic syndrome at age 43 was ascertained using the International Diabetes Federation criteria. Odds ratios and CIs for risk of the metabolic syndrome and its components by snus use at 16, 21, 30 and 43 years were calculated using logistic regression. Cumulative snus use was defined as number of life periods (1-4) with current snus use.

    Results: At age 43, 164 participants (18.6%) were current snus users. We found no association between exclusive snus use at the ages of 16, 21, 30 and 43 years and the metabolic syndrome at age 43 years. Snus use (among non-smokers) was associated with raised triglycerides and high blood pressure in crude analysis, but not in multivariable models. There was no association between cumulative snus use and risk of the metabolic syndrome. Cumulative snus use was associated with central obesity, raised triglycerides and impaired fasting glucose/diabetes mellitus type 2 in crude analyses, but not after adjustments.

    Conclusions: The health consequences of snus exposure from adolescence to mid-adulthood do not seem to include increased risk of the metabolic syndrome or its components. The cardio-metabolic risk of dual exposure to snus and cigarettes may warrant further attention.

  • 19.
    Carlsson, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Anderzén, I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Motivationfor return to work and actual return to work among people on long-term sickleave due to pain syndrome or mental health conditions2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    ABSTRACTPurpose:The purpose of this study was to investigate associations between motivation for return towork and actual return to work, or increased employability among people on long-term sick leave.Materials and methods:Data by responses to questionnaires was collected from 227 people on long-term sick leave (mean¼7.9years) due to pain syndrome or mild to moderate mental health conditionswho had participated in a vocational rehabilitation intervention. The participants’motivation for return towork was measured at baseline. At 12-month follow-up, change in the type of reimbursement betweenbaseline and at present was assessed and used to categorise outcomes as:“decreased work and employ-ability”,“unchanged”,“increased employability”,and“increased work”. Associations between baselinemotivation and return to work outcome were analysed using logistic and multinomial regression models.Results:Motivation for return to work at baseline was associated with return to work or increasedemployability at 12-month follow-up in the logistic regression model adjusting for potential confounders(OR 2.44, 95% CI 1.25–4.78).Conclusions:The results suggest that motivation for return to work at baseline was associated withactual chances of return to work or increased employability in people on long-term sick leave due topain syndrome or mild to moderate mental health conditions.

  • 20. Delfabbro, Paul H
    et al.
    Winefield, Helen R
    Winefield, Anthony H
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Epidemiologi och global hälsa.
    Mid-Adolescent Predictors of Adult Drinking Levels in Early Adulthood and Gender Differences: Longitudinal Analyses Based on the South Australian School Leavers Study.2016In: Journal of addiction, ISSN 2090-7834, Vol. 2016Article in journal (Refereed)
    Abstract [en]

    There is considerable public health interest in understanding what factors during adolescence predict longer-term drinking patterns in adulthood. The aim of this study was to examine gender differences in the age 15 social and psychological predictors of less healthy drinking patterns in early adulthood. The study investigates the relative importance of internalising problems, other risky health behaviours, and peer relationships after controlling for family background characteristics. A sample of 812 young people who provided complete alcohol consumption data from the age of 15 to 20 years (5 measurement points) were drawn from South Australian secondary schools and given a detailed survey concerning their psychological and social wellbeing. Respondents were classified into two groups based upon a percentile division: those who drank at levels consistently below NHMRC guidelines and those who consistently drank at higher levels. The results showed that poorer age 15 scores on measures of psychological wellbeing including scores on the GHQ-12, self-esteem, and life-satisfaction as well as engagement in health-related behaviours such as smoking or drug-taking were associated with higher drinking levels in early adulthood. The pattern of results was generally similar for both genders. Higher drinking levels were most strongly associated with smoking and marijuana use and poorer psychological wellbeing during adolescence.

  • 21. Delfabbro, Paul
    et al.
    Stevenson, J
    Malvaso, C
    Duong, D
    Winefield, Anthony
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Who is doing well: Age 15 predictors of psychological and physical health in young adulthoodIn: Australian psychologist, ISSN 0005-0067, E-ISSN 1742-9544Article in journal (Refereed)
  • 22.
    Eriksson, Malin
    et al.
    Umea Univ, Dept Social Work, S-90187 Umea, Sweden.
    Ghazinour, Mehdi
    Umea Univ, Police Educ Unit, Umea, Sweden.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Different uses of Bronfenbrenner’s ecological theory in public mental health research: what is their value for guiding public mental health policy and practice?2018In: Social Theory & Health, ISSN 1477-8211, E-ISSN 1477-822X, Vol. 16, no 4, p. 414-433Article in journal (Refereed)
    Abstract [en]

    Bronfenbrenner’s ecological theory is appealing as a conceptual tool for guiding public mental health interventions. However, his theory underwent significant changes since its first inception during the late 1970s until his death in 2005, due to which the implications that can be drawn might differ depending on what concepts (i.e. early or later) of the theory is utilized. The aim of this paper was to examine how different concepts of Bronfenbrenner’s theory have been utilized in (public) mental health research, and to analyse the value of these different uses for guiding public mental health policy and practice. A systematic search for articles that have utilized concepts of Bronfenbrenner’s theory within the field of mental health resulted in a review of 16 published papers. We found that one set of papers (N = 10) used the early concepts of ecological systems without investigating interactions between these systems, while another set of papers used the concepts of ecological systems by also investigating interactions within and between these systems (N = 4). Another limited set of papers (N = 2) utilized the later concepts of proximal processes and the PPCT model. Our results show that studies using Bronfenbrenner’s ecological system concepts by clearly considering interactions between and within these systems can result in recommendations that are most useful for guiding public mental health policy and practice.

  • 23.
    Ersson, Emelie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Kalrsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Äldres upplevelse av smärta vid kirurgi: En kvalitativ intervjustudie2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 24. Ervasti, Jenni
    et al.
    Kivimäki, Mika
    Head, Jenny
    Goldberg, Marcel
    Airagnes, Guillaume
    Pentti, Jaana
    Oksanen, Tuula
    Salo, Paula
    Suominen, Sakari
    Jokela, Markus
    Vahtera, Jussi
    Zins, Marie
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Sickness absence diagnoses among abstainers, low-risk drinkers and at-risk drinkers: consideration of the U-shaped association between alcohol use and sickness absence in four cohort studies2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 9, p. 1633-1642Article in journal (Refereed)
    Abstract [en]

    Aims To estimate differences in the strength and shape of associations between alcohol use and diagnosis-specific sickness absence. Design A multi-cohort study. Participants (n = 47 520) responded to a survey on alcohol use at two time-points, and were linked to records of sickness absence. Diagnosis-specific sickness absence was followed for 4-7 years from the latter survey. Setting and participants From Finland, we had population cohort survey data from 1998 and 2003 and employee cohort survey data from 2000-02 and 2004. From France and the United Kingdom, we had employee cohort survey data from 1993 and 1997, and 1985-88 and 1991-94, respectively. Measurements We used standard questionnaires to assess alcohol intake categorized into 0, 1-11 and > 11 units per week in women and 0, 1-34 and > 34 units per week in men. We identified groups with stable and changing alcohol use over time. We linked participants to records from sickness absence registers. Diagnoses of sickness absence were coded according to the International Classification of Diseases. Estimates were adjusted for sex, age, socio-economic status, smoking and body mass index. Findings Women who reported drinking 1-11 units and men who reported drinking 1-34 units of alcohol per week in both surveys were the reference group. Compared with them, women and men who reported no alcohol use in either survey had a higher risk of sickness absence due to mental disorders [rate ratio = 1.51, 95% confidence interval (CI) = 1.22-1.88], musculoskeletal disorders (1.22, 95% CI = 1.06-1.41), diseases of the digestive system (1.35, 95% CI = 1.02-1.77) and diseases of the respiratory system (1.49, 95% CI = 1.29-1.72). Women who reported alcohol consumption of > 11 weekly units and men who reported alcohol consumption of > 34 units per week in both surveys were at increased risk of absence due to injury or poisoning (1.44, 95% CI = 1.13-1.83). Conclusions In Finland, France and the United Kingdom, people who report not drinking any alcohol on two occasions several years apart appear to have a higher prevalence of sickness absence from work with chronic somatic and mental illness diagnoses than those drinking below a risk threshold of 11 units per week for women and 34 units per week for men. Persistent at-risk drinking in Finland, France and the United Kingdom appears to be related to increased absence due to injury or poisoning.

  • 25. Ervasti, Jenni
    et al.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Lallukka, Tea
    Friberg, Emilie
    Mittendorfer-Rutz, Ellenor
    Lundström, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Alexanderson, Kristina
    Trends in diagnosis-specific work disability before and after ischaemic heart disease: a nationwide population-based cohort study in Sweden.2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 4, article id e019749Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We examined trends of diagnosis-specific work disability before and after ischaemic heart disease (IHD).

    DESIGN: Participants were followed 4 years before and 4 years after an IHD event for diagnosis-specific work disability (sickness absence and disability pension).

    SETTING AND PARTICIPANTS: A Swedish population-based cohort study using register data on all individuals aged 25-60 years, living in Sweden, and who suffered their first IHD event in 2006-2008 (n=23 971) was conducted.

    RESULTS: Before the event, the most common diagnoses of work disability were musculoskeletal disorders (21 annual days for men and 44 for women) and mental disorders (19 men and 31 for women). After multivariable adjustments, we observed a fivefold increase (from 12 to 60 days) in work disability due to diseases of the circulatory system in the first postevent year compared with the last pre-event year among men. Among women, the corresponding increase was fourfold (from 14 to 62 days). By the second postevent year, the number of work disability days decreased significantly compared with the first postevent year among both sexes (to 19 days among men and 23 days among women). Among women, mean days of work disability due to diseases of the circulatory system remained at a higher level than among men during the postevent years. Work disability risk after versus before an IHD event was slightly higher among men (rate ratio (RR) 2.49; 95% CI 2.36 to 2.62) than among women (RR 2.29, 95% CI 2.12 to 2.49). When pre-event long-term work disability was excluded, diseases of the circulatory system were the most prevalent diagnosis for work disability after an IHD event among both men and women.

    CONCLUSIONS: An IHD event was strongly associated with an increase in work disability due to diseases of the circulatory system, especially among men and particularly in the first postevent year.

  • 26.
    Gustafsson, Per
    et al.
    Umeå Unniversity.
    Bozorgmehr, K
    Umeå universitet.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    San Sebastian, M
    Umeå University.
    What role does adolescent neighborhood play for adult health? Across-classified multilevel analysis of life course models in Northern Sweden2017In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 46, p. 137-144Article in journal (Refereed)
  • 27.
    Hakulinen, Christian
    et al.
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Helsinki, Finland; Natl Inst Hlth & Welf, Helsinki, Finland.
    Pulkki-Råback, Laura
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Helsinki, Finland.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Finnish Inst Occupat Hlth, Helsinki, Finland.
    Jokela, Markus
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Helsinki, Finland.
    Kivimäki, Mika
    UCL, Dept Epidemiol & Publ Hlth, London, England; Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Elovainio, Marko
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Helsinki, Finland; Natl Inst Hlth & Welf, Helsinki, Finland.
    Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women2018In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 104, no 18, p. 1536-1542Article in journal (Refereed)
    Abstract [en]

    Objective: To examine whether social isolation and loneliness (1) predict acute myocardial infarction (AMI) and stroke among those with no history of AMI or stroke, (2) are related to mortality risk among those with a history of AMI or stroke, and (3) the extent to which these associations are explained by known risk factors or pre-existing chronic conditions.

    Methods: Participants were 479 054 individuals from the UK Biobank. The exposures were self-reported social isolation and loneliness. AMI, stroke and mortality were the outcomes.

    Results: Over 7.1 years, 5731 had first AMI, and 3471 had first stroke. In model adjusted for demographics, social isolation was associated with higher risk of AMI (HR 1.43, 95% CI 1.3 to –1.55) and stroke (HR 1.39, 95% CI 1.25 to 1.54). When adjusted for all the other risk factors, the HR for AMI was attenuated by 84% to 1.07 (95% CI 0.99 to 1.16) and the HR for stroke was attenuated by 83% to 1.06 (95% CI 0.96 to 1.19). Loneliness was associated with higher risk of AMI before (HR 1.49, 95% CI 1.36 to 1.64) but attenuated considerably with adjustments (HR 1.06, 95% CI 0.96 to 1.17). This was also the case for stroke (HR 1.36, 95% CI 1.20 to 1.55 before and HR 1.04, 95% CI 0.91 to 1.19 after adjustments). Social isolation, but not loneliness, was associated with increased mortality in participants with a history of AMI (HR 1.25, 95% CI 1.03 to 1.51) or stroke (HR 1.32, 95% CI 1.08 to 1.61) in the fully adjusted model.

    Conclusions: Isolated and lonely persons are at increased risk of AMI and stroke, and, among those with a history of AMI or stroke, increased risk of death. Most of this risk was explained by conventional risk factors.

  • 28. Halonen, Jaana I
    et al.
    Lallukka, Tea
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Rod, Naja
    Magnusson Hanson, Linda
    Bi-directional relation between effort‒reward imbalance and risk of neck-shoulder pain: assessment of mediation through depressive symptoms using occupational longitudinal data2018In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990XArticle in journal (Refereed)
    Abstract [en]

    Objectives Bi-directional associations between perceived effort‒reward imbalance (ERI) at work and neck-shoulder pain have been reported. There is also evidence of associations between ERI and depressive symptoms, and between depressive symptoms and pain while the links between ERI, depressive symptoms and pain have not been tested. We aimed to assess whether depressive symptoms mediate the association between ERI and neck-shoulder pain, as well as the association between neck-shoulder pain and ERI.

    Methods We used prospective data from three consecutive surveys of the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. ERI was assessed with a short version of the ERI questionnaire, and pain was defined as having had neck-shoulder pain that affected daily life during the past three months. Depressive symptoms were assessed with a continuous scale based on six-items of the (Hopkins) Symptom Checklist. Counterfactual mediation analyses were applied using exposure measures from 2010/2012 (T1), depressive symptoms from 2012/2014 (T2), and outcomes from 2014/2016 (T3), and including only those free of outcome at T1 and T2 (N=2876‒3239).

    Results ERI was associated with a higher risk of neck-shoulder pain [risk ratio (RR) for total effect 1.24, 95% confidence interval (CI) 1.02–1.50] and 40% of this total effect was mediated through depressive symptoms. Corresponding RR for association between neck-shoulder pain and ERI was 1.36 (95% CI 1.13–1.65), but the mediating role of depressive symptoms was less consistent.

    Conclusions Depressive symptoms appear to be an intermediate factor in the relationship between ERI and neck-shoulder pain.

  • 29. Halonen, Jaana I
    et al.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Ala-Mursula, Leena
    Miettunen, Jouko
    Vaaramo, Eeva
    Karppinen, Jaro
    Kouvonen, Anne
    Lallukka, Tea
    Socioeconomic and health-related childhood and adolescence predictors of entry into paid employment2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360XArticle in journal (Refereed)
    Abstract [en]

    Background

    Most studies on prolonging working careers have explored later career, while less is known about social and particularly health-related determinants of entry into labour market. We examined social and health-related factors from childhood and adolescence as predictors of age at entry into paid employment and early occupational class, and whether own education moderates these associations.

    Methods

    The Northern Finland Birth Cohort 1986 was followed from birth until the end of 2015. We included 8542 participants (52% male) who had had a minimum of 6-month employment that was defined by registered earning periods. As socioeconomic predictors, we examined low parental education at age 7 and low household income at age 16. Behaviour- and health-related factors at age 16 included smoking, alcohol use, physical inactivity, overweight, length of sleep and not having breakfast, while mental health problems included symptoms of anxiety and depression, attention problems and social problems. The analyses for significant predictors were further stratified by register-based level of completed own education by age 28–29 (low/high).

    Results

    After adjustments, low parental education, smoking and having been drunk were significant predictors of early entry into paid employment (≤18 vs. ≥24 years), especially among those who later obtained high education. Low parental education and smoking were predictors of low or non-specified (vs. high) occupational class in the first job. Mental health problems were not associated with either outcome.

    Conclusions

    Socioeconomic background and unhealthy lifestyle contribute to early entry into the labour market and low occupational status in the first job.

  • 30. Halonen, Jaana
    et al.
    Merikukka, Marko
    Gissler, Mika
    Kerkelä, Martta
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Ristikari, Tiina
    Hiilamo, Heikki
    Lallukka, Tea
    Pathways from parental mental disorders to offspring's work disability due to depressive or anxiety disorders in early adulthood-: The 1987 Finnish Birth Cohort2018In: Depression and anxiety (Print), ISSN 1091-4269, E-ISSN 1520-6394Article in journal (Refereed)
    Abstract [en]

    Background

    Parental mental disorders have been shown to predict offspring's mental health problems. We examined whether pathways from parental mental disorders to offspring's psychiatric work disability in early adulthood are mediated through offspring's mental disorders and social disadvantage in adolescence.

    Methods

    Study population consisted of the 1987 Finnish Birth Cohort. Data on parents’ psychiatric care or work disability due to mental diagnosis between 1987 and 2000 and the cohort participants’ health and social factors between 2001 and 2005 were derived from administrative national registers. From 2006 through 2015, 52,182 cohort participants were followed for admittance of psychiatric work disability due to depressive or anxiety disorders. First, we applied a pathway analysis to examine the occurrence of each path. We then used mediation analysis to assess the proportion of association between parental mental disorders and work disability mediated by offspring's health and social disadvantage.

    Results

    The pathway model indicated that the association from parental mental disorders to offspring's work disability due to depressive or anxiety disorder is through mental disorders and social disadvantage in adolescence. Odds Ratio for the total effect of parental mental disorders on offspring's psychiatric work disability was 1.85 (95% confidence interval [CI] 1.46–2.34) in the model including offspring's mental disorders that mediated this association by 35%. Corresponding results were 1.86 (95% CI 1.47–2.35) and 28% for social disadvantage in adolescence.

    Conclusions

    These findings suggest that intergenerational determination of work disability due to mental disorders could be addressed by actions supporting mental health and social circumstances in adolescence.

  • 31.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Allmänmedicin.
    A Tool for Developing Gender Research in Medicine: Examples from the Medical Literature on Work Life.2007In: Gender Medicine, ISSN 1550-8579, E-ISSN 1878-7398, Vol. 4S2, p. S123-S132Article in journal (Refereed)
  • 32.
    Hammarström, Anne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Hensing, Gunnel
    Univ Gothenburg, Sahlgrenska Acad, Sect Social Med, Dept Publ Hlth & Community Med, Gothenburg, Sweden.
    How gender theories are used in contemporary public health research2018In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, article id 34Article in journal (Refereed)
    Abstract [en]

    Background: Public health research often focuses on gender differences within certain diagnoses, but so far research has failed to explain these differences in a satisfactory way. Theoretical development could be one prerequisite for moving beyond categorical thinking. The aim of this paper was to analyse how gender theories have been used in public health research in relation to various methodological approaches. Method: Six special issues of gender research with public health relevance (comprising 33 papers in total) were identified from a search of PubMed and Web of Science, spanning a 10-year period. The papers were analysed inductively through posing questions to the text. Results: Gender theories were used in eight different ways: 1. to test hypotheses, 2. integrate theories, 3. develop gender concepts and models, 4. interpret findings, 5. understand health problems, 6. illustrate the validity of other theories, 7. integrated into a gender blind theory, as well as to 8. critique of other gender theories. The strategies applied seemed independent of the health aspects of the papers. However, the methodologies were of importance, indicating that both theoretical papers and papers using qualitative methodologies used almost all available strategies, while papers using quantitative empirical research used a limited number of strategies. Conclusions: This study contributes to identifying how gender theories are used in contemporary public health research, which can help researchers move beyond a categorical understanding of gender in health research.

  • 33.
    Hammarström, Anne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Korhonen, J.
    Uppsala University.
    Blomqvist, I.
    Uppsala University.
    Hägglöf, B.
    Umeå Univ, Umeå, Sweden..
    Increase of internalised mental health symptoms over the last 33 years among adolescents2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27Article in journal (Other academic)
  • 34.
    Hammarström, Anne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Socialmedicin.
    Westerlund, Hugo
    Kirves, Kaisa
    Nygren, Karina
    Umeå universitet, Socialmedicin.
    Virtanen, Pekka
    Umeå universitet, Socialmedicin.
    Hägglöf, Bruno
    Umeå universitet, Barn- och ungdomspsykiatri.
    Addressing challenges of validity and internal consistency of mental health measures in a 27- year longitudinal cohort study–the Northern Swedish Cohort study2016In: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 16, article id 4Article in journal (Refereed)
    Abstract [en]

    Background:There are inherent methodological challenges in the measurement of mental health problems in longitudinal research. There is constant development in definitions, taxonomies and demands concerning the properties of mental health measurements. The aim of this paper was to construct composite measures of mental health problems (according to today’s standard) from single questionnaire items devised in the early 1980s, and to evaluate their internal consistency and factorial invariance across the life course using the Northern Swedish Cohort.Methods:All pupils in the last year of compulsory school in Luleå in 1981 (n= 1083) form a prospective cohort study where the participants have been followed with questionnaires from the age of 16 (in 1981) until the age of43 (in 2008). We created and tested the following composite measures from self-reports at each follow-up:depressive symptoms, anxiety symptoms, functional somatic symptoms, modified GHQ and positive health. Validity and internal consistency were tested by confirmatory factor analysis, including tests of factorial invariance over time.Results:As an overall assessment, the results showed that the composite measures (based on more than 30-year-old single item questions) are likely to have acceptable factorial invariance as well as internal consistency over time.Conclusions:Testing the properties of the mental health measures used in older studies according to the standards of today is of great importance in longitudinal research. Our study demonstrates that composite measures of mental health problems can be constructed from single items which are more than 30 years old and that these measures seem to have the same factorial structure and internal consistency across a significant part of the life course. Thus, it can be possible to overcome some specific inherent methodological challenges in using historical data in longitudinal research.

  • 35. Harkko, Jaakko
    et al.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kouvonen, Anne
    Unemployment and work disability due to common mental disorders among young adults: selection or causation?2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 5, p. 791-797Article in journal (Refereed)
  • 36.
    Harryson, Lisa
    et al.
    Umeå universitet, Allmänmedicin.
    Aléx, Lena
    Umeå universitet, Institutionen för omvårdnad.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Allmänmedicin.
    “An equal share, that’s my medicine”. Experiences of domestic work, health and illness from a gender relational perspective.Manuscript (preprint) (Other academic)
    Abstract [en]

    Introduction: Gender inequalities in domestic work have been shown to be related to mental illness among both women and men. The aim of this study was to analyse experiences of domestic work, health and illness among women and men from a gender relational perspective. Methods: A strategic section from the Northern Swedish Cohort of four women and four men living in couple relationships with children was included in the study. The strategic selection included variation socioeconomic class and perception of gender equality in the couple relationship. Interviews were conducted in 2012 when the participants were 47 years old. Data collection and analysis was performed with a Grounded Theory approach. Results: We identified three categories. “Living with the burden of domestic work –an obstacle for women’s health” was built on women’s experiences of having the main responsibility for everyday domestic work as burdensome, stressful and something that caused sleeping and mental illness problems. “Being trapped in an outmoded masculinity – a stressful situation” was built on men’s experiences of domestic work such as fixing things that were broken at home as well as having responsibility for the seasonal outdoor work, something that was connected to feelings of stress. “Negotiating gender equality” included women’s and men’s experiences of striving for gender equality in the couple relationship as a possible way to improved health. Conclusions: Gender relations are an important part of how the domestic work is unequally organized and related to experiences of mental illness. We found that gender constructions in the domestic sphere included various dimensions of gender inequality that were constantly negotiated in order to improve health.

  • 37.
    Harryson, Lisa
    et al.
    Umeå universitet, Sociologiska institutionen.
    Aléx, Lena
    Umeå universitet, Institutionen för omvårdnad.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Epidemiologi och global hälsa.
    "I have surly passed a limit, it is simply too much": women's and men's experiences of stress and wellbeing when living within a process of housework resignation2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 224Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Gender inequality within paid and unpaid work exposes women and men to different environments and responsibilities. These gender patterns shape living conditions for women and men, either negatively or positively, by affecting the prospect of good health. Most public health studies of gender and housework are quantitative, and knowledge about the relationship between housework experiences and health for women and men is limited. The aim of this study was to explore the housework experiences and practices of women and men and their experiences of stress and perceived wellbeing from a gender perspective.

    METHODS: We conducted thematic interviews with four women and four men living in Sweden, and performed an analysis using the Grounded Theory method.

    FINDINGS: We found that stereotypical gender practices in housework influenced experiences of stress and perceived wellbeing among women and men. Despite proposing gender equality in housework as a means of improving wellbeing, inequality was amplified by the way women and men handle the gendered division of housework. We call this recurring theme "The process of housework resignation", which also constitute the core category in our analysis. "The process of housework resignation" was theorised from the categories "Gender practices in housework", "Experiencing stress and wellbeing" and "Managing daily life".

    CONCLUSIONS: Stereotypical gender practices in housework can increase experiences of stress among women and men. Challenging stereotypical masculinities can be a key for breaking the process of resignation in housework and for facilitating improved health among both women and men in heterosexual couple relationships within a Swedish context.

  • 38.
    Hjorth, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Sjöberg, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Svanberg, Anncarin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Dalarna University, Falun, Sweden.
    Kaminsky, Elenor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Langenskiöld, Sophie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Economics.
    Rorsman, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
    Nurse-led clinic for patients with liver cirrhosis-effects on health-related quality of life: study protocol of a pragmatic multicentre randomised controlled trial.2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 10, article id e023064Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Liver cirrhosis affects health-related quality of life (HRQoL) even in its early stages. Morbidity is especially high when the disease decompensates and self-care actions become essential. Nurse involvement in secondary prevention in other chronic diseases has contributed to better symptom control, less need of inpatient care and improved HRQoL. In order to evaluate the impact of nurse involvement in the follow-up of patients with liver cirrhosis, we decided to compare structured nurse-led clinics, inspired by Dorothea Orem's nursing theory and motivational strategies, with a group of patients receiving standard care. The primary outcome is HRQoL and the secondary outcomes are quality of care, visits to outpatient clinics or hospitals, disease progress and health literacy.

    METHODS AND ANALYSIS: This is a pragmatic, multicentre randomised controlled study conducted at six Swedish hepatology departments. Eligible patients are adults with diagnosed cirrhosis of the liver (n=500). Participants are randomised into either an intervention with nurse-led follow-up group or into a standard of care group. Recruitment started in November 2016 and is expected to proceed until 2020. Primary outcomes are physical and mental HRQoL measured by RAND-36 at enrolment, after 1 and 2 years.

    ETHICS AND DISSEMINATION: The study is ethically approved by the Regional Ethical Review Board in Uppsala. The results shall be disseminated in international conferences and peer-reviewed articles.

    TRIAL REGISTRATION NUMBER: NCT02957253; Pre-results.

  • 39.
    Hultin, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Lindblom, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Hur föräldrar upplever delaktighet i vården, när deras barn vårdas på barnintensivvårdsavdelning2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Tidenpå barnintensivvårdsavdelningen (BIVA) kan vara en traumatiserande tid för bådebarnet och dess föräldrar. Föräldrarna kan må bättre genom att delta i vårdenav barnet. Föräldrafokuserad omvårdnad (FFO) inbjuder till delaktighet därföräldrarna får möjlighet att fungera och definiera sin nya roll som förälderoch fortsätta vara ett stöd till sitt barn. Ett av fundamenten i FFO ärinformation. Föräldrarna behöver vara välinformerade om sitt barns tillståndoch vårdplaneringen. Ett ömsesidigt informationsflöde var viktigt, därföräldrarna gavs möjlighet att delge information om sitt barn och bli lyssnadepå. Vid lyckad FFO uppstod ett partnerskap byggt på ömsesidig respekt ochförtroende. Föräldrarnas och barnets stressreaktion var kopplade och kunde ledatill posttraumatiskt stressyndrom (PTSD) hos bägge upp till ett år efterutskrivningen från sjukhus.

  • 40.
    Jonsson, Frida
    et al.
    Umeå Univ, Unit Epidemiol & Global Hlth, Dept Publ Hlth & Clin Med, Umeå, Sweden.
    San Sebastian, Miguel
    Umeå Univ, Unit Epidemiol & Global Hlth, Dept Publ Hlth & Clin Med, Umeå, Sweden.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Gustafsson, Per E.
    Umeå Univ, Unit Epidemiol & Global Hlth, Dept Publ Hlth & Clin Med, Umeå, Sweden.
    Are neighbourhood inequalities in adult health explained by socio-economic and psychosocial determinants in adolescence and the subsequent life course in northern Sweden?: A decomposition analysis2018In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 52, p. 127-134Article in journal (Refereed)
    Abstract [en]

    This study explains neighbourhood deprivation inequalities in adult health for a northern Swedish cohort by examining the contribution of socio-economic and psychosocial determinants from adolescence (age 16), young adulthood (age 21) and midlife (age 42) to the disparity. Self-reported information from 873 participants was drawn from questionnaires, with complementary neighbourhood register data. The concentration index was used to estimate the inequality while decomposition analyses were run to attribute the disparity to its underlying determinants. The results suggest that socio-economic and psychosocial factors in midlife explain a substantial part, but also that the inequality can originate from conditions in adolescence and young adulthood.

  • 41.
    Jonsson, Frida
    et al.
    Umea Univ, Unit Epidemiol & Global Hlth, Dept Publ Hlth & Clin Med, S-90185 Umea, Sweden..
    San Sebastian, Miguel
    Umea Univ, Unit Epidemiol & Global Hlth, Dept Publ Hlth & Clin Med, S-90185 Umea, Sweden..
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Gustafsson, Per E.
    Umea Univ, Unit Epidemiol & Global Hlth, Dept Publ Hlth & Clin Med, S-90185 Umea, Sweden..
    Intragenerational social mobility and functional somatic symptoms in a northern Swedish context: analyses of diagonal reference models2017In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, article id 1Article in journal (Refereed)
    Abstract [en]

    Background: Research indicate that social class mobility could be potentially important for health, but whether this is due to the movement itself or a result of people having been integrated in different class contexts is, to date, difficult to infer. In addition, although several theories suggest that transitions between classes in the social hierarchy can be stressful experiences, few studies have empirically examined whether such movements may have health effects, over and above the implications of "being" in these classes. In an attempt to investigate whether intragenerational social mobility is associated with functional somatic symptoms in mid-adulthood, the current study tests three partially contrasting theories. Method: The dissociative theory suggests that mobility in general and upward mobility in particular may be linked to psychological distress, while the falling from grace theory indicates that downward mobility is especially stressful. In contrast, the acculturation theory holds that the health implications of social mobility is not due to the movement itself but attributed to the class contexts in which people find themselves. Diagonal Reference Models were used on a sample of 924 individuals who in 1981 graduated from 9th grade in the municipality of Lulea, Sweden. Social mobility was operationalized as change in occupational class between age 30 and 42 (measured in 1995 and 2007). The health outcome was functional somatic symptoms at age 42, defined as a clustering self-reported physical symptoms, palpitation and sleeping difficulties during the last 12 months. Results: Overall mobility was not associated with higher levels of functional somatic symptoms compared to being immobile (p = 0.653). After controlling for prior and current class, sex, parental social position, general health, civil status, education and unemployment, the association between downward mobility was borderline significant (p = 0.055) while upward mobility was associated with lower levels of functional somatic symptoms (p = 0.03). Conclusion: The current study did not find unanimous support for any of the theories. Nevertheless, it sheds light on the possibility that upward mobility may be beneficial to reduce stress-related health problems in mid-life over and above the exposure to prior and current class, while downward mobility can be of less importance for middle-age health complaints.

  • 42.
    Jonsson, Frida
    et al.
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    San Sebastian, Miguel
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Stromsten, Lotta M. J.
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Gustafsson, Per E
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Life Course Pathways of Adversities Linking Adolescent Socioeconomic Circumstances and Functional Somatic Symptoms in Mid-Adulthood: A Path Analysis Study2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, article id e0155963Article in journal (Refereed)
    Abstract [en]

    While research examining the health impact of early socioeconomic conditions suggests that effects may exist independently of or jointly with adult socioeconomic position, studies exploring other potential pathways are few. Following a chain of risk life course model, this prospective study seeks to examine whether pathways of occupational class as well as material and social adversities across the life course link socioeconomic disadvantage in adolescent to functional somatic symptoms in mid-adulthood. Applying path analysis, a multiple mediator model was assessed using prospective data collected during 26 years through the Northern Swedish Cohort. The sample contained 987 individuals residing in the municipality of Lulea, Sweden, who participated in questionnaire surveys at age 16, 21, 30 and 42. Socioeconomic conditions (high/low) in adolescence (age 16) were operationalized using the occupation of the parents, while occupational class in adulthood (manual/nonmanual) was measured using the participant's own occupation at age 21 and 30. The adversity measurements were constructed as separate age specific parcels at age 21 and 30. Social adversity included items pertaining to stressful life events that could potentially harm salient relationships, while material adversity was operationalized using items concerning unfavorable financial and material circumstances. Functional somatic symptoms at age 42 was a summary measure of self-reported physical symptoms, palpitation and sleeping difficulties that had occurred during the last 12 months. An association between socioeconomic conditions at age 16 and functional somatic symptoms at age 42 (r = 0.068) which was partially explained by people's own occupational class at age 21 and then material as well as social adversity at age 30 was revealed. Rather than proposing a direct and independent health effect of the socioeconomic conditions of the family, the present study suggests that growing up in an unfavorable socioeconomic environment might be a source for a chain of adverse material and social living situations, which in turn affects adult health.

  • 43. Juvani, Anne
    et al.
    Oksanen, Tuula
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Finnish Inst Occupat Hlth, Helsinki, Finland.
    Salo, Paula
    Pentti, Jaana
    Kivimäki, Mika
    Vahtera, Jussi
    Clustering of job strain, effort-reward imbalance, and organizational injustice and the risk of work disability: a cohort study2018In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, no 5, p. 485-495Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to examine the association between co-occurring work stressors and risk of disability pension.

    Methods The work stressors job strain, effort−reward imbalance (ERI), and organizational injustice were measured by a survey in 2008 of 41 862 employees linked to national records of all-cause and cause-specific disability pensions until 2011. Co-occurring work stressors were examined as risk factors of work disability using Cox regression marginal models.

    Results Work stressors were clustered: 50.8% had no work stressors [observed-to-expected ratio (O/E)=1.2], 27.4% were exposed to one stressor (O/E=0.61–0.81), 17.7% to two stressors (O/E=0.91–1.73) and 6.4% to all three stressors (O/E=2.59). During a mean follow-up of 3.1 years, 976 disability pensions were granted. Compared to employees with no work stressors, those with (i) co-occurring strain and ERI or (ii) strain, ERI and injustice had a 1.9–2.1-fold [95% confidence interval (CI) 1.7–2.6] increased risk of disability retirement. The corresponding hazard ratios were 1.2 and 1.5 (95% CI 1.0–1.8) for strain and ERI alone. Risk of disability pension from depressive disorders was 4.4–4.7-fold (95% CI 2.4–8.0) for combinations of strain+ERI and strain+ERI+injustice, and 1.9–2.5-fold (95% CI 1.1–4.0) for strain and ERI alone. For musculoskeletal disorders, disability risk was 1.6–1.9-fold (95% CI 1.3–2.3) for strain+ERI and ERI+injustice combinations, and 1.3-fold (95% CI 1.0–1.7) for strain alone. Supplementary analyses with work stressors determined using work-unit aggregates supported these findings.

    Conclusions Work stressors tend to cluster in the same individuals. The highest risk of disability pension was observed among those with work stressor combinations strain+ERI or strain+ERI+injustice, rather than for those with single stressors.

  • 44.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England;Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland.
    Pentti, Jaana
    Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland;Univ Turku, Dept Publ Hlth, Turku, Finland.
    Ferrie, Jane E.
    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England;UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Nyberg, Solja T.
    Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland.
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden;Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Dragano, Nico
    Univ Dusseldorf, Med Fac, Inst Med Sociol, Dusseldorf, Germany.
    Fransson, Eleonor I.
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden;Jonkoping Univ, Sch Hlth & Welf, Jonkoping, Sweden;Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Goldberg, Marcel
    INSERM, Populat Based Epidemiol Cohorts Unit, UMS 011, Villejuif, France;Versailles St Quentin Univ, UMS 011, Villejuif, France.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Koskinen, Aki
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kouvonen, Anne
    Univ Helsinki, Fac Social Sci, Helsinki, Finland;Queens Univ Belfast, Ctr Publ Hlth, Adm Data Res Ctr Northern Ireland, Belfast, Antrim, North Ireland;SWPS Univ Social Sci & Humanities Wroclaw, Div Hlth Psychol, Wroclaw, Poland.
    Luukkonen, Ritva
    Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland.
    Oksanen, Tuula
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark;Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark;Univ Copenhagen, Dept Psychol, Copenhagen, Denmark.
    Siegrist, Johannes
    Univ Dusseldorf, Med Fac, Inst Med Sociol, Dusseldorf, Germany.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England;Ctr Res Epidemiol & Populat Hlth, INSERM, UMR 1018, Villejuif, France.
    Suominen, Sakari
    Folkhalsan Res Ctr, Helsinki, Finland;Univ Skovde, Sch Hlth & Educ, Skovde, Sweden;Univ Kent, Sch Social Policy Sociol & Social Res, Canterbury, Kent, England;Univ Turku, Dept Publ Hlth, Turku, Finland.
    Theorell, Töres
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden;Finnish Inst Occupat Hlth, Helsinki, Finland.
    Väänänen, Ari
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Vahtera, Jussi
    Turku Univ Hosp, Turku, Finland;Univ Turku, Dept Publ Hlth, Turku, Finland.
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Zins, Marie
    INSERM, Populat Based Epidemiol Cohorts Unit, UMS 011, Villejuif, France;Versailles St Quentin Univ, UMS 011, Villejuif, France.
    Strandberg, Timo
    Helsinki Univ Hosp, Dept Internal Med, Helsinki, Finland;Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland;Univ Oulu, Ctr Life Course Hlth Res, Oulu, Finland.
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Deanfield, John
    UCL, Natl Ctr Cardiovasc Prevent & Outcomes, London, England.
    Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study2018In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 6, no 9, p. 705-713Article in journal (Refereed)
    Abstract [en]

    Background: Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.

    Methods: In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.

    Results: We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13.9 years [SD 3.9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149.8 per 10 000 person-years) than in those without (97.7 per 10 000 person-years; mortality difference 52.1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1.68, 95% CI 1.19-2.35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78.1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5.9-44.0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2.01, 95% CI 1.18-3.43) and those with normal blood pressure and no dyslipidaemia (6.17, 1.74-21.9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6.6 per 10 000 person-years; multivariable-adjusted HR 1.22, 1.06-1.41).

    Interpretation: In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.

  • 45.
    Landstedt, Evelina
    et al.
    Umeå universitet, Epidemiologi och global hälsa.
    Almquist, Ylva B.
    Eriksson, Malin
    Umeå universitet, Epidemiologi och global hälsa.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umeå universitet, Epidemiologi och global hälsa.
    Disentangling the directions of associations between structural social capital and mental health: Longitudinal analyses of gender, civic engagement and depressive symptoms2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 163, p. 135-143Article in journal (Refereed)
    Abstract [en]

    The present paper analysed the directions of associations between individual-level structural social capital, in the form of civic engagement, and depressive symptoms across time from age 16-42 years in Swedish men and women. More specifically, we asked whether civic engagement was related to changes in depressive symptoms, if it was the other way around, or whether the association was bi-directional. This longitudinal study used data from a 26-year prospective cohort material of 1001 individuals in Northern Sweden (482 women and 519 men). Civic engagement was measured by a single-item question reflecting the level of engagement in clubs/organisations. Depressive symptoms were assessed by a composite index. Directions of associations were analysed by means of gender-separate cross-lagged structural equation models. Models were adjusted for parental social class, parental unemployment, parental health, and family type at baseline (age 16). Levels of both civic engagement and depressive symptoms were relatively stable across time. The model with the best fit to data showed that, in men, youth civic engagement was negatively associated with depressive symptoms in adulthood, thus supporting the hypothesis that involvement in social networks promotes health, most likely through provision of social and psychological support, perceived influence, and sense of belonging. Accordingly, interventions to promote civic engagement in young men could be a way to prevent poor mental health for men later on in life. No cross-lagged effects were found among women. We discuss this gender difference in terms of gendered experiences of civic engagement which in turn generate different meanings and consequences for men and women, such as civic engagement not being as positive for women's mental health as for that of men. We conclude that theories on structural social capital and interventions to facilitate civic engagement for health promoting purposes need to acknowledge gendered life circumstances. (C) 2016 Elsevier Ltd. All rights reserved.

  • 46.
    Landstedt, Evelina
    et al.
    Umea Univ, Dept Publ Hlth & Clincial Med Epidemiol & Global, Umea, Sweden..
    Brydsten, Anna
    Umea Univ, Dept Publ Hlth & Clincial Med Epidemiol & Global, Umea, Sweden..
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Umea Univ, Dept Publ Hlth & Clincial Med Epidemiol & Global, Umea, Sweden..
    Virtanen, Pekka
    Univ Tampere, Sch Hlth Sci, Tampere, Finland..
    Almquist, Ylva B.
    Stockholm Univ, Karolinska Inst, Ctr Hlth Equ Studies CHESS, Stockholm, Sweden..