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Haukenes I, Hammarström A. Workplace gender composition and sickness absence: A register-based study from Sweden. Scand J Public Health 2024; 52:678-684. [PMID: 37265198 PMCID: PMC11308254 DOI: 10.1177/14034948231176108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/01/2023] [Accepted: 04/29/2023] [Indexed: 06/03/2023]
Abstract
AIMS This study aimed to examine the association between gender composition in the workplace and sickness absence days during a one-year period. METHODS The study population was drawn from the Northern Swedish Cohort (wave 3; 2007) by Statistics Sweden and consisted of all participants belonging to a specific workplace (n=837) as well as all co-workers at the workplace of the participants (n=132,464; 67,839 women and 64,625 men). Exposure was the gender composition of the workplace, and outcome was cumulative sickness absence days (⩾90 days or not) during 2007, provided through a link to the Database for Health Insurance and Labour Marked Studies of Statistics Sweden. Covariates were gender, age, educational level and branch of industry from the same data source. We performed descriptive analyses and multivariable regression analyses. RESULTS Workers in extremely female-dominated workplaces had a significantly higher risk of cumulative sickness absence days (⩾90 days) compared with gender-equal workplaces (fully adjusted odds ratio (OR)=1.27; 95% confidence interval (CI) 1.09-1.48), whereas those working in extremely and moderately male-dominated workplaces had a significantly lower sickness absence risk (OR=0.62 and 0.66, respectively). Stratified by gender, the higher absence risk at female-dominated workplaces was fully explained by variation in branches of industry. Women working in extremely male-dominated workplaces had a significantly lower absence risk (OR=0.75), as did men working in moderately male-dominated workplaces (OR=0.78). CONCLUSIONS Workplaces dominated by women had a significantly higher risk of days lost to sickness absence compared to gender-equal workplaces. Stratified by gender, this higher risk was explained by branch of industry.
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Affiliation(s)
- Inger Haukenes
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Research Unit for General Practice, NORCE – Norwegian Research Centre, Norway
| | - Anne Hammarström
- IMM, Karolinska Institutet, Sweden
- Department of Epidemiology and Global Health, Umeå University, Sweden
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Hagström AS, Hammarström A. A life marked by early school leaving: gendered working life paths linked to health and well-being over 40 years. BMC Public Health 2024; 24:1966. [PMID: 39044168 PMCID: PMC11264424 DOI: 10.1186/s12889-024-19447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND There is increasing awareness of the need to analyse symptoms of mental ill-health among early school leavers. Dropping out of compulsory education limits access to the labour market and education and could be related to deteriorating mental health over the course of a lifetime. The aim of this longitudinal study is to explore how early school leavers not in education, employment or training (NEET) narrate their working life trajectories linked to health, agency and gender relations. METHODS Twelve early school leavers in the Swedish Northern Cohort (six women and six men) were interviewed over 40 years about their working life and health. Their life stories were analysed using structural narrative analysis to examine the evolution of their working life paths and to identify commonalities, variations and gendered patterns. RESULTS All the participants started in the same position of "an unhealthy gendered working life in youth due to NEET status". Subsequently, three distinct working life paths evolved: "a precarious gendered working life with negative health implications", "a stable gendered working life in health challenging jobs" and "a self-realising gendered working life with improved health". Agency was negotiated through struggle narratives, survival narratives, coping narratives and redemption narratives. CONCLUSIONS Even in a welfare regime like Sweden's in the early 1980s, early school leavers not in education, employment or training experienced class-related and gendered working and living conditions, which created unequal conditions for health. Despite Sweden's active labour market policies and their own practices of agency, the participants still ended up NEET and with precarious working life paths. Labour market policies should prioritise reducing unemployment, combating precarious employment, creating job opportunities, providing training and subsidised employment in healthy environments, and offering grants to re-enter further education. Our study highlights the need for further analyses of the contextual and gendered expressions of health among early school leavers throughout their lifetime, and of individual agency in various contexts for overcoming adversities.
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Affiliation(s)
| | - Anne Hammarström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Hammarström A, Westerlund H, Janlert U, Virtanen P, Ziaei S, Östergren PO. How do labour market conditions explain the development of mental health over the life-course? a conceptual integration of the ecological model with life-course epidemiology in an integrative review of results from the Northern Swedish Cohort. BMC Public Health 2024; 24:1315. [PMID: 38750531 PMCID: PMC11094982 DOI: 10.1186/s12889-024-18461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/27/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The aim of this study was to contribute to the theoretical development within the field of labour market effects on mental health during life by integrating Bronfenbrenner's ecological model with mainly earlier theoretical work on life-course theory. METHODS An integrative review was performed of all 52 publications about labour market conditions in relation to mental health from the longitudinal Northern Swedish Cohort study. Inductive and deductive qualitative content analysis were performed in relation to Bronfenbrenner's ecological framework combined with life-course theories. RESULTS The following nine themes were identified: 1. Macroeconomic recession impairs mental health among young people. 2. The mental health effects on individuals of youth unemployment seem rather insensitive to recession. 3. Small but consistent negative effect of neighbourhood unemployment and other work-related disadvantaged on individuals' mental health over life. 4. Youth unemployment becomes embodied as scars of mental ill-health over life. 5. Weak labour market attachment impairs mental health over life. 6. Bidirectional relations between health and weak labour market attachment over life. 7. Macrolevel structures are of importance for how labour market position cause poor health. 8. Unequal gender relations at work impacts negatively on mental health. 9. The agency to improve health over life in dyadic relations. Unemployment in society permeates from the macrolevel into the exolevel, defined by Bronfenbrenner as for example the labour market of parents or partners or the neighbourhood into the settings closest to the individual (the micro- and mesolevel) and affects the relations between the work, family, and leisure spheres of the individual. Neighbourhood unemployment leads to poor health among those who live there, independent of their employment status. Individuals' exposure to unemployment and temporary employment leads to poorer mental health over the life-course. Temporal dimensions were identified and combined with Bronfenbrenner levels into a contextual life-course model CONCLUSION: Combining the ecosocial theory with life-course theories provides a framework for understanding the embodiment of work-related mental health over life. The labour market conditions surrounding the individual are of crucial importance for the embodiment of mental health over life, at the same time as individual agency can be health promoting. Mental health can be improved by societal efforts in regulations of the labour market.
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Affiliation(s)
- Anne Hammarström
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, Stockholm, 113 65, Sweden.
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Hugo Westerlund
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Urban Janlert
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Pekka Virtanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Shirin Ziaei
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, Stockholm, 113 65, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
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Virtanen P, Nummi T, Westerlund H, Östergren PO, Janlert U, Hammarström A. Active labour market policies in emerging adulthood may act as a protective factor against future depressiveness: an analysis of the long-term trajectories of depressive symptoms in the Northern Swedish Cohort. Front Public Health 2024; 12:1345034. [PMID: 38655526 PMCID: PMC11035740 DOI: 10.3389/fpubh.2024.1345034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Drawing upon the framework of life course epidemiology, this study aligns with research on the mental health consequences of significant social transitions during early adulthood. The focus is on the variation in initial labour market attachment and the development of depressiveness, assuming that a firm attachment is associated with decreasing depressiveness. Methods The baseline investigation of the studied cohort (n = 1,001) took place during their final year of compulsory schooling at age 16. Follow-up surveys were conducted at ages 18, 21, 30, and 43. Depressiveness was measured with a five-item score. Multiple trajectory analysis, incorporating five labour market statuses observed over seven half-year periods from ages 18 to 21, was employed to categorize the cohort into six distinct groups. Among these, 'All-time education,' 'From education to employment,' 'Education and employment,' and 'From employment to education' were considered to demonstrate firm labour market attachment. Meanwhile, 'Active labour market policy' and 'Unemployment' represented less firm attachment. Results The trajectory of depressive symptoms among the total cohort from age 16 to age 43 exhibited a 'broken stick' pattern, reaching its lowest point at age 21. This pattern was evident in all groups classified as having a firm attachment. A substantial decrease in depressiveness was also observed in the relatively weakly attached 'Active labour market policy' group, whereas no 'broken stick' pattern emerged in the 'Unemployment' group. The disparities in the levels of depressiveness observed at age 21 remained relatively stable across the measurements at ages 30 and 43. Discussion The results were as expected, except for the observed improvement in mental health within the 'Active labour market policy' group. Supported labour market attachment during emerging adulthood can enhance mental well-being similarly to regular mainstream attachment. In terms of policy recommendations, the consistently high levels of depressiveness within the 'Unemployment' group underscore the importance of reducing long-term and repeated unemployment in young age. The findings regarding the 'Active labour market policy' provide evidence of the intervention's benefits. While the primary goal of these measures is to create jobs for the unemployed, they also include elements that contribute to participants' mental health.
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Affiliation(s)
- Pekka Virtanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Karolinska Institutet, Stockholm, Sweden
| | - Tapio Nummi
- Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Hugo Westerlund
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Per-Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Urban Janlert
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Virtanen P, Nummi T, Janlert U, Hammarström A. Psychosocial conditions during school-age as determinants of long-term labour market attachment: a study of the Northern Swedish Cohort from the 1980s to the 2020s. BMC Public Health 2024; 24:191. [PMID: 38229043 PMCID: PMC10790433 DOI: 10.1186/s12889-023-17611-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND This study, conducted on a Swedish population cohort, explores how internalized (depressive and functional somatic) and externalized (smoking, drinking, truancy, vandalism, delinquency) mental health symptoms, as well as close interpersonal relations (family climate and school connectedness) reported during adolescence, influence the work-life course up to late midlife. METHODS We examined repeated measurements of labour market status from age 16 to 56 using sequence analyses. We identified five different labour market attachment (LMA16-56) trajectories, namely 'strong,' 'early intermediate,' 'early weak,' 'late weak,' and 'constantly weak.' Multinomial logistic regressions were employed to relate each of the nine determinants to the identified trajectories. RESULTS When compared to the risk of 'strong' LMA16-56, adversity in all conditions, except for vandalism, entailed a higher risk of the 'constantly weak' trajectory. Moreover, all conditions, except for functional somatic symptoms, entailed a higher risk of the 'late weak' LMA16-56. The risk of the 'early intermediate' LMA16-56 was non-significant across all the conditions. CONCLUSIONS This study contributes to existing knowledge through its novel exploration of labour market attachment and the revelation of the significance of proximal interpersonal relationships in attachment outcomes. Additionally, the study reaffirms the importance of externalizing behaviour, while suggesting that internalized symptoms in adolescence might have a less influential, though not negligible, role. These results underscore the importance of addressing acting out behaviour and nurturing human relationships during compulsory basic education, when the entire age group is still within reach. This approach aims not only to reduce frictions in the school-to-work transition but also to prevent midlife labour market attachment problems that may arise with delayed intervention.
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Affiliation(s)
| | | | | | - Anne Hammarström
- Umeå University, Umeå, Sweden
- Karolinska Institutet, Stockholm, Sweden
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Hammarström A, Bean C, Pingel R, Janlert U, Westerlund H, Östergren PO, Virtanen P. Why does youth unemployment lead to scarring of depressive symptoms in adulthood? The importance of early adulthood drinking. Scand J Public Health 2023:14034948231208472. [PMID: 38153038 DOI: 10.1177/14034948231208472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
AIM The aim of the paper is to analyse if alcohol consumption could explain the scarring effect of youth unemployment on later depressive symptoms. METHODS The analyses are based on the 24-year follow-up of school leavers in a municipality in Northern Sweden (the Northern Swedish Cohort). Four-way decomposition analyses were performed to analyse if alcohol use at age 30 years could mediate and/or moderate the effect of youth unemployment (ages 18/21 years) on depressive symptoms in later adulthood (age 43 years). RESULTS Excessive alcohol use at early adulthood (age 30 years) mediates 18% of the scarring effect of youth unemployment on depressive symptoms in later adulthood. The scarring effect was seen among both those with and without excessive alcohol use. CONCLUSIONS Youth unemployment leads to poor mental health later in life and part of these relations are explained by excessive alcohol consumption in early adulthood. Policy interventions should target the prevention of youth unemployment for reaching a lower alcohol consumption and better mental health.
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Affiliation(s)
- Anne Hammarström
- IMM, Karolinska Institutet, Sweden
- Department of Epidemiology and Global Health, Umeå University, Sweden
| | | | - Ronnie Pingel
- Department of Statistics, Uppsala University, Sweden
| | - Urban Janlert
- Department of Epidemiology and Global Health, Umeå University, Sweden
| | | | - Per Olof Östergren
- Social Medicine and Global Health, Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Pekka Virtanen
- IMM, Karolinska Institutet, Sweden
- Faculty of Social Sciences, Tampere University, Finland
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Ziaei S, Hammarström A. The relationship between interpersonal violence in adulthood and mental health: a longitudinal study based on the Northern Swedish Cohort. BMC Public Health 2023; 23:637. [PMID: 37013550 PMCID: PMC10071752 DOI: 10.1186/s12889-023-15525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 03/25/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Longitudinal studies evaluating the negative effects of exposure to interpersonal violence in the adulthood on the mental health of both women and men are scarce. Using longitudinal data, we evaluated the relationship between the last year experience of violence and functional somatic and depressive symptoms at the ages of 30 and 43 among participants (n = 1006; 483 women and 523 men) in the Northern Swedish Cohort. Further, the relationship between cumulative exposure to violence over a decade and mental health symptoms among participants was evaluated. METHODS Participants' experience of interpersonal violence and symptoms of functional somatic and depressive symptoms were evaluated with standard questionnaires at the ages of 30 and 43. General linear models were used to evaluate the relationship between the experience of interpersonal violence and mental health symptoms among the participants. The interactions between gender and violence on functional somatic and depressive symptoms were evaluated separately, and models in which the interaction was significant, were split by gender. RESULTS We found that the last year experience of violence at the age of 30 was related to current functional somatic symptoms among all participants and depressive symptoms only among men, (β Adj for the experience of any violence among men: 0.21; CI: 0.12-0.29; Vs. among women: 0.06; CI: -0.04-0.16, p for interaction = 0.02). At the age of 43, last year experience of violence was related to both functional somatic and depressive symptoms in both genders. Finally, a cumulative relationship between the experience of violence over time and mental health symptoms was observed in all participants. CONCLUSIONS Our findings revealed that while the relationship between the experience of interpersonal violence and mental health symptoms may differ among men and women and with age, the experience of violence can be negatively related to the mental health in both genders.
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Affiliation(s)
- Shirin Ziaei
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, 113 65 Stockholm, Stockholm, Sweden.
| | - Anne Hammarström
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, 113 65 Stockholm, Stockholm, Sweden
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
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Diderichsen F, Janlert U. Gunnar Inghe: A founding father of Scandinavian social medicine and still highly relevant. Scand J Public Health 2023:14034948221149763. [PMID: 36718023 DOI: 10.1177/14034948221149763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Gunnar Inghe (1910-1977) was a founding father of Scandinavian social medicine and the first editor of the Scandinavian Journal of Social Medicine. He worked as a physician for social care clients in Stockholm from 1944 to 1961 and was professor in social medicine from 1961 to 1975. We (F.D. and U.J.) were his last two PhD students. As we were recollecting the 50-year history of the Scandinavian Journal of Public Health in 2022, it became evident to us how relevant Gunnar Inghe's work, 45 years after his death, still is for today's social medicine, population health research and policy in Scandinavia. We shall explain why with five examples of Inghe's work: reproductive health, health of paupers, foundation of the discipline, international solidarity and collaboration between medical and social care.
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Affiliation(s)
| | - Urban Janlert
- Department of Epidemiology and Global Health, Umeå University, Sweden
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Berg N, Nummi T, Bean CG, Westerlund H, Virtanen P, Hammarström A. Risk factors in adolescence as predictors of trajectories of somatic symptoms over 27 years. Eur J Public Health 2022; 32:696-702. [PMID: 35904464 PMCID: PMC9527955 DOI: 10.1093/eurpub/ckac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Somatic symptoms among adolescents are common, yet little is known about long-term trajectories of somatic symptoms and the factors in adolescence that shape them. We examined individual, family and school-based factors at age 16 as predictors of trajectories of somatic symptoms over 27 years. METHODS Participants from the Northern Swedish Cohort (n = 1001) responded to questions about individual factors (e.g. health behaviours), family factors (e.g. contact with parents, social and material adversity) and school satisfaction at age 16; as well as 10 somatic symptoms at ages 16, 18, 21, 30 and 43. Teacher assessments at age 16 included overall ability at school and peer relations. Age 16 predictors of somatic symptom trajectory group membership were analysed using multinomial logistic regression. RESULTS Poor contact with mother and poor school satisfaction were significant predictors of adverse symptom trajectories among both men and women. Low birth weight and low parental academic involvement were contributing factors for women, while smoking and social adversity were more relevant factors for men. CONCLUSIONS Our findings emphasize the importance of a holistic approach that considers the unique contributions of individual, family and school-based factors in the development of trajectories of somatic symptoms from adolescence to middle age.
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Affiliation(s)
- Noora Berg
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Tapio Nummi
- Faculty of Information Technology and Communication Sciences/Statistics, Tampere University, Tampere, Finland
| | - Christopher G Bean
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Hugo Westerlund
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Pekka Virtanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anne Hammarström
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet Stockholm, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Norström F, Hammarström A. Methodological perspectives on the study of the health effects of unemployment - reviewing the mode of unemployment, the statistical analysis method and the role of confounding factors. BMC Med Res Methodol 2022; 22:199. [PMID: 35864450 PMCID: PMC9306210 DOI: 10.1186/s12874-022-01670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/29/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Studying the relationship between unemployment and health raises many methodological challenges. In the current study, the aim was to evaluate the sensitivity of estimates based on different ways of measuring unemployment and the choice of statistical model. Methods The Northern Swedish cohort was used, and two follow-up surveys thereof from 1995 and 2007, as well as register data about unemployment. Self-reported current unemployment, self-reported accumulated unemployment and register-based accumulated unemployment were used to measure unemployment and its effect on self-reported health was evaluated. Analyses were conducted with G-computation, logistic regression and three estimators for the inverse probability weighting propensity scores, and 11 potentially confounding variables were part of the analyses. Results were presented with absolute differences in the proportion with poor self-reported health between unemployed and employed individuals, except when logistic regression was used alone. Results Of the initial 1083 pupils in the cohort, our analyses vary between 488–693 individuals defined as employed and 61–214 individuals defined as unemployed. In the analyses, the deviation was large between the unemployment measures, with a difference of at least 2.5% in effect size when unemployed was compared with employed for the self-reported and register-based unemployment modes. The choice of statistical method only had a small influence on effect estimates and the deviation was in most cases lower than 1%. When models were compared based on the choice of potential confounders in the analytical model, the deviations were rarely above 0.6% when comparing models with 4 and 11 potential confounders. Our variable for health selection was the only one that strongly affected estimates when it was not part of the statistical model. Conclusions How unemployment is measured is highly important when the relationship between unemployment and health is estimated. However, misspecifications of the statistical model or choice of analytical method might not matter much for estimates except for the inclusion of a variable measuring health status before becoming unemployed. Our results can guide researchers when analysing similar research questions. Model diagnostics is commonly lacking in publications, but they remain very important for validation of analyses. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01670-1.
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Affiliation(s)
- Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Anne Hammarström
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.,Institute of Environmental Medicine, Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
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Veldman K, Pingel R, Hallqvist J, G Bean C, Hammarström A. How does social support shape the association between depressive symptoms and labour market participation: a four-way decomposition. Eur J Public Health 2021; 32:8-13. [PMID: 34871391 PMCID: PMC9090166 DOI: 10.1093/eurpub/ckab185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Little is known about factors that may explain the association between depressive symptoms and poor labour market participation (LMP). The aim of this study is to examine the mediation and interaction effects of social support on the association between depressive symptoms and LMP. Methods Data were used from 985 participants (91% of the initial cohort) of the Northern Swedish Cohort, a longitudinal study of Swedish participants followed from adolescence throughout adulthood. Depressive symptoms were measured at age 16, social support at age 21 and LMP from age 30 to 43. Poor LMP was defined as being unemployed for a total of 6 months or more between the ages of 30 and 43. A four-way decomposition approach was applied to identify direct, mediation and interaction effects, together and separately. Results Both depressive symptoms during adolescence and social support at young adulthood were associated with poor LMP [odds ratio (OR) = 1.70, 95% confidence interval (CI) 1.17–2.47 and OR = 2.56, 95% CI 1.78-3.68 respectively]. The association between depressive symptoms and poor LMP was partially mediated by a lack of social support. No interaction effect of a lack of social support was found. Conclusion The results suggest that depressive symptoms influence not only later LMP but also the intermediary level of social support, and in turn influencing later LMP. Recommendations for public health are to detect and treat depressive symptoms at an early stage and to focus on the development of social skills, facilitating the increased availability of social support, thereby improving future LMP.
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Affiliation(s)
- Karin Veldman
- Department of Health Sciences, Community & Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ronnie Pingel
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Johan Hallqvist
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Christopher G Bean
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,School of Psychology, University of Adelaide, Australia
| | - Anne Hammarström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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12
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Ziaei S, Hammarström A. What social determinants outside paid work are related to development of mental health during life? An integrative review of results from the Northern Swedish Cohort. BMC Public Health 2021; 21:2190. [PMID: 34847924 PMCID: PMC8638423 DOI: 10.1186/s12889-021-12143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite global increase in burden of mental health conditions, longitudinal studies on factors related to development of mental health are scarce. Particularly integrated understanding of how factors at each level of ecological system interact to influence mental health of individuals during their life is missing. Both work and outside work (life beyond work) spheres are two important areas in human life which can have independent effects on mental health of individuals. In this integrative review, we aimed to synthesis findings about social determinants outside paid work that are related to development of mental health during life in a 27-year prospective Swedish Cohort study by using Bronfenbrenner's Ecological Systems Theory. METHODS The material for this paper consists of all mental health related papers within Northern Swedish Cohort. Papers related to outside paid work exposures of life circumstances were selected. An integrative review was conducted on 27 papers and deductive qualitative content analysis in relation to Bronfenbrenner ecological framework was performed to identify the main themes. RESULTS The results of this review showed that class structures and gender order at macro-level permeated into all other levels and finally became embodied in the individuals as symptoms of mental health during life. At the "exo-level" neighbourhood disadvantage was related to mental ill-health of individuals. The importance of parental interaction with other settings, like school, for mental health of individuals was highlighted at "meso-level". At "micro-level" poor social relationships; social and material adversities and inequality in gender relations during adult life were related to mental ill-health. CONCLUSION We found mental health of individuals to be related to both unique and common factors manifesting at different socio-ecological levels. Social structures at the macro-level namely class structures and gender order permeate all other levels and eventually become embodied in the individuals as symptoms of mental health during life. Interventions addressing gender and class related inequalities might be of importance for improving mental health of individuals during their life.
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Affiliation(s)
- Shirin Ziaei
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, 113 65, Stockholm, Stockholm, Sweden.
| | - Anne Hammarström
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, 113 65, Stockholm, Stockholm, Sweden.,Department of Epidemiology and Global Health, Umea University, 901 87, Umea, Sweden
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Hammarström A, Lundman B, Norberg A. The importance of having a paid job. Gendered experiences of health and ill-health in daily life among middle-aged women and men. BMC Public Health 2021; 21:2023. [PMID: 34742259 PMCID: PMC8572442 DOI: 10.1186/s12889-021-12034-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background More gender-theoretical studies are needed to gain a deeper understanding of what life circumstances make people sick or improve their health. The aim of the study was to gain a deeper understanding of social determinants of health by exploring gendered experiences in daily life among middle-aged women and men using the theory of gender relations. Methods Individual interviews with nine men and women were performed, focusing on what made them feel good or bad. Qualitative content analysis was used to analyse the data. Results A major theme in our interviews was the gendered health-promoting experiences related to having a job, which involved becoming someone, feeling appreciated at work and having control over work. Having good family relations was also health-promoting, in terms of supportive relations and becoming a parent. Ill-health was related to gendered adverse conditions at work (accidents, monotonous and stressful work tasks, being bullied) and in domestic life (demands, destructive partner relations, having children with problems). Conclusions Gendered determinants of health and ill-health were identified in both working and domestic life. Public health policy needs to challenge the gender order in society, which defines the gendered structure of the labour market as well as the gendered relations in domestic life.
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Affiliation(s)
- Anne Hammarström
- IMM, Karolinska Institutet, Stockholm, Sweden. .,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Berit Lundman
- Department of Nursing, Umeå University, Umeå, Sweden
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14
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Arithmetical Analysis of Gender-Based Relative Behavior on Life Satisfaction and Self-esteemed Mental Health. HUMAN ARENAS 2021. [DOI: 10.1007/s42087-020-00116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Laugesen K, Ludvigsson JF, Schmidt M, Gissler M, Valdimarsdottir UA, Lunde A, Sørensen HT. Nordic Health Registry-Based Research: A Review of Health Care Systems and Key Registries. Clin Epidemiol 2021; 13:533-554. [PMID: 34321928 PMCID: PMC8302231 DOI: 10.2147/clep.s314959] [Citation(s) in RCA: 211] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/05/2021] [Indexed: 12/19/2022] Open
Abstract
The Nordic countries are Denmark, Finland, Iceland, Norway, and Sweden and comprise a total population of approximately 27 million. The countries provide unique opportunities for joint health registry-based research in large populations with long and complete follow-up, facilitated by shared features, such as the tax-funded and public health care systems, the similar population-based registries, and the personal identity number as unique identifier of all citizens. In this review, we provide an introduction to the health care systems, key registries, and how to navigate the practical and ethical aspects of setting up such studies. For each country, we provide an overview of population statistics and health care expenditures, and describe the operational and administrative organization of the health care system. The Nordic registries provide population-based, routine, and prospective data on individuals lives and health with virtually complete follow-up and exact censoring information. We briefly describe the total population registries, birth registries, patient registries, cancer registries, prescription registries, and causes of death registries with a focus on period of coverage, selected key variables, and potential limitations. Lastly, we discuss some practical and legal perspectives. The potential of joint research is not fully exploited, mainly due to legal and practical difficulties in, for example, cross-border sharing of data. Future tasks include clear and transparent legal pathways and a framework by which practical aspects are facilitated.
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Affiliation(s)
- Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mika Gissler
- Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden and Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
| | - Unnur Anna Valdimarsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Center of Public Health Science, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Astrid Lunde
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,KOR, The Danish Advisory Board on Register Based Research, the Danish e-infrastructure Cooperation, Copenhagen, Denmark
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Virtanen P, Hammarström A, Janlert U. Locked in Permanent Employment-Longitudinal Associations With Depressive and Functional Somatic Symptoms. J Occup Environ Med 2021; 63:588-593. [PMID: 34184651 DOI: 10.1097/jom.0000000000002190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study mental health as a precedent and an outcome of not being in the preferred job ("locked-in situation"). METHODS Longitudinal data from age 16 to 43 were derived from surveys of the Northern Swedish Cohort. Changes in mental health were studied with analyses of variance for repeated measures. RESULTS Getting out of locked-in situation was associated with improving and getting into locked-in with worsening mental health between age 30 and age 43. The worsening was more pronounced and the improvement less pronounced in white-collar than in blue-collar employees. Poor mental health at age 16 predicted locked-in situation in early middle age. CONCLUSIONS The findings clarify the bidirectional nature of the associations between locked-in situation and poor mental health, as well as the importance of social class in assessing these associations.
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Affiliation(s)
- Pekka Virtanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland (Mr Virtanen); Institute of Environmental Medicine, Karolinska Institutet, Stockholm (Mr Virtanen, Ms Hammarström); Department of Epidemiology and Global Health, Umeå University, Umeå (Mr Janlert), Sweden
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17
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Gunnarsdóttir H, Hensing G, Hammarström A. Poor school connectedness in adolescence and adulthood depressiveness: a longitudinal theory-driven study from the Northern Sweden Cohort. Eur J Public Health 2021; 31:797-802. [PMID: 33846734 PMCID: PMC8504995 DOI: 10.1093/eurpub/ckab027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Foundations for mental health are laid early in family and school life. Family climate embraces the emotional connections within a family, and school connectedness embraces both functional and affective dimensions of relationship with school. Based on the lack of theory-driven and longitudinal epidemiological studies addressing public mental health, the aim of this longitudinal study was to investigate the associations between adolescents’ school connectedness, family climate and depressiveness in adulthood, by relying on Bronfenbrenner’s ecological theory. Methods The data are from the Northern Swedish Cohort, and the sample consists of 481 women and 526 men born in 1965 who participated in data collection at age 16, 21, 30 and 43. The generalized linear model method with random intercepts was used to examine the associations between family climate and school connectedness and depressiveness in adulthood. Results Poor school connectedness was associated with depressiveness in adulthood [β = 0.038 (95% CI 0.018–0.058) P ≤ 0.001], but poor family climate was not [β = 0.014 (95% CI −0.004–0.032)]. No difference in associations was observed between those experiencing social/material adversities in adolescence. Conclusions This study shows that poor school connectedness in adolescence can affect depressiveness in adulthood. The study confirms the complex processes that determine mental health and proposes a theoretical approach appealing to public mental health research. In addition, this study concludes that more life-course studies are needed to advance the knowledge of the mechanisms behind the associations between family climate and school connectedness and depressiveness in adulthood.
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Affiliation(s)
- Hrafnhildur Gunnarsdóttir
- Department of Health Sciences, University West, Trollhättan, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anne Hammarström
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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18
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Hammarström A, Ahlgren C. Living in the shadow of unemployment -an unhealthy life situation: a qualitative study of young people from leaving school until early adult life. BMC Public Health 2019; 19:1661. [PMID: 31823760 PMCID: PMC6905008 DOI: 10.1186/s12889-019-8005-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background Despite the magnitude of youth unemployment there is a lack of studies, which explore the relations between health experiences and labour market position in various contexts. The aim of this paper was to analyse health experiences among young people in NEET (not in education, employment or training) in relation to labour market position from leaving school until early adult life. Method The population consists of everyone (six women, eight men) who became unemployed directly after leaving compulsory school in a town in Northern Sweden. Repeated personal interviews were performed from age 16 until age 33. The interviews were analysed using qualitative content analysis. Results Health experiences can be viewed as a contextual process, related to the different phases of leaving school, entering the labour market, becoming unemployed and becoming employed. Perceived relief and hope were related to leaving compulsory school, while entering the labour market was related to setbacks and disappointments as well as both health-deteriorating and health-promoting experiences depending on the actual labour market position. Our overarching theme of “Living in the shadow of unemployment – an unhealthy life situation” implies that it is not only the actual situation of being unemployed that is problematic but that the other phases are also coloured by earlier experiences of unemployment . Conclusion A focus on young people’s health experiences of transitions from school into the labour market brings a new focus on the importance of macroeconomic influence on social processes and contextualised mechanisms from a life-course perspective.
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Affiliation(s)
- Anne Hammarström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. .,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Christina Ahlgren
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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19
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Blomqvist I, Henje Blom E, Hägglöf B, Hammarström A. Increase of internalized mental health symptoms among adolescents during the last three decades. Eur J Public Health 2019; 29:925-931. [PMID: 30859217 PMCID: PMC6761841 DOI: 10.1093/eurpub/ckz028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Previous studies suggest an overall increase of adolescent mental health symptoms globally since the 1980s until today, especially an increase of internalizing symptoms in girls. Due to methodological limitations of these studies, further studies are warranted to obtain a more solid knowledgebase. Methods This study was cross-sectional and compared two separate but geographically identical groups of adolescents in a middle-sized industrial municipality in Northern Sweden at two time-points [(i) 1981, n = 1083, (505 girls, 577 boys), response rate 99.7%; (ii) 2014, n = 682, (338 girls, 344 boys), response rate 98.3%]. All students in their last year of compulsory school were included. The same self-report questionnaire, consisting of four sub-scales (functional somatic-, anxiety-, depressive symptoms and conduct problems), was used at both occasions. Data were analyzed with descriptive statistics, two-way ANOVA and general linear model. Results Symptoms of anxiety and depression and functional somatic symptoms, increased among both boys and girls from 1981 until 2014 (P < 0.001 for all subscales), and the increase of these symptoms was higher in girls. Conduct problems were significantly higher in boys in 1981 and decreased over time so that in 2014 there was no longer a significant difference between boys and girls regarding conduct problems (P = 0.286). Conclusion In this population-based study spanning over 30 years, both girls and boys showed increasing internalizing problems, while conduct problems decreased. To halt this trend, we need a deeper understanding of the impact of the major societal changes that have occurred during the last three decades.
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Affiliation(s)
- Ida Blomqvist
- Department of Clinical Science, Child and Adolescent Psychiatry, Umeå University, Umeå, Sweden
| | - Eva Henje Blom
- Department of Clinical Science, Child and Adolescent Psychiatry, Umeå University, Umeå, Sweden
| | - Bruno Hägglöf
- Department of Clinical Science, Child and Adolescent Psychiatry, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
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20
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Hammarström A, Virtanen P. The importance of financial recession for mental health among students: short- and long-term analyses from an ecosocial perspective. J Public Health Res 2019; 8:1504. [PMID: 31579674 PMCID: PMC6761466 DOI: 10.4081/jphr.2019.1504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 05/23/2019] [Indexed: 12/03/2022] Open
Abstract
Background and aim: Referring to the ecosocial theory and utilising the ‘natural experiment’ setting provided by the global recession at the beginning of 1990s, the aim of our study was to analyse the short- and long-term associations between trade and mental health in young students followed until mid-adulthood. Method: The study was based on two prospective cohort studies, the older and the younger Northern Swedish Cohort which both consisted of all pupils in a middle-sized industrial town in Northern Sweden. At age 21, the younger cohort entered the labour market during the deep recession of the early 1990s, while the older cohort entered the labour market during the boom of the 1980s. Both cohorts were followed up with a high response rate in mid adulthood. For this study, all students were selected at age 21. Results: At age 21, those who studied during recession had more depressive and functional somatic symptoms than those who studied during boom. The cohort differences did not remain over age: by the follow-up in early middle age the differences between the cohorts were non-significant, most notably due to decreased depressive symptoms in the younger cohort and increase of functional somatic symptoms in the older cohort. Conclusions: The short-term mental health consequences of the business cycle seem to be more extensive than limited only to those who are unemployed, even though the possible long-term consequences seem to be more complex. Thus, the macrolevel had a great short-term impact on the individual level in relation to the microlevel setting of university/school. The chronosystem was also of major importance. Future research would benefit from taking the context into account. Significance for public health Although those who study at age 21 may be considered as a relatively healthy and advantaged population group in the long run, our results provide evidence for the significance of recession for mental health, not only among those suffering from concrete job loss but across all population groups. Students’ mental health should be given high priority during times of financial crisis. Mental health services for students should receive increased resources during times of recession. Even if young people may be reluctant to study after school during a financial crisis, it seems to be beneficial for their mental health in a long-term perspective. So, for them poorer mental health does not seem to be dangerous in the long run. Students surveys should pay special attention to understanding the relation between macroeconomic conditions and individual mental health symptoms.
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Affiliation(s)
- Ann Hammarström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,The Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Pekka Virtanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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21
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Lallukka T, Mekuria GB, Nummi T, Virtanen P, Virtanen M, Hammarström A. Co-occurrence of depressive, anxiety, and somatic symptoms: trajectories from adolescence to midlife using group-based joint trajectory analysis. BMC Psychiatry 2019; 19:236. [PMID: 31370894 PMCID: PMC6670180 DOI: 10.1186/s12888-019-2203-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/02/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Co-occurrence of mental and somatic symptoms is common, and recent longitudinal studies have identified single trajectories of these symptoms, but it is poorly known whether the symptom trajectories can also co-occur and change across the lifespan. We aimed to examine co-occurring symptoms and their joint trajectories from adolescence to midlife. METHODS Longitudinal data were derived from Northern Sweden, where 506 girls and 577 boys aged 16 years participated at baseline in 1981 (99.7% of those initially invited), and have been followed up in four waves until the age of 43. Survey data were collected about depressive, anxiety, and somatic symptoms. Potential joint development of this three-component symptom set was examined with multiple response trajectory analysis, a method that has not been previously used to study co-occurrence of these symptoms. RESULTS We identified a five trajectory solution as the best: "very low" (19%), "low" (31%), "high" (22%), "late sharply increasing" (16%) and a "very high increasing" (12%). In the "late sharply increasing" and "very high increasing" groups the scores tended to increase with age, while in the other groups the levels were more stable. Overall, the results indicated that depressive, anxiety, and somatic symptoms co-exist from adolescence to midlife. CONCLUSIONS The multiple response trajectory analysis confirmed high stability in the co-occurrence of depressive, anxiety, and somatic symptoms from adolescence to midlife. Clinicians should consider these findings to detect symptoms in their earliest phase in order to prevent the development of co-occurring high levels of symptoms.
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Affiliation(s)
- Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland. .,Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Gashaw B. Mekuria
- 0000 0001 2314 6254grid.502801.eUniversity of Tampere, Faculty of Social Sciences, Tampere, Finland
| | - Tapio Nummi
- 0000 0001 2314 6254grid.502801.eUniversity of Tampere, School of Natural Sciences, Tampere, Finland
| | - Pekka Virtanen
- 0000 0001 2314 6254grid.502801.eUniversity of Tampere, Faculty of Social Sciences, Tampere, Finland
| | - Marianna Virtanen
- 0000 0001 0726 2490grid.9668.1School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Anne Hammarström
- 0000 0001 1034 3451grid.12650.30Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden ,0000 0004 1936 9377grid.10548.38Stress Research Institute, Stockholm University, Sweden and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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22
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Lundman B, Hammarström A, Ahlgren C, Norberg A. Use of the model of Inner Strength for analysing reflective interviews in a group of healthy middle-aged adults. SAGE Open Med 2019; 7:2050312119856812. [PMID: 31217970 PMCID: PMC6560797 DOI: 10.1177/2050312119856812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 05/19/2019] [Indexed: 11/17/2022] Open
Abstract
Objective: Inner Strength has been described as a human resource that promotes well-being linked to health. The aim of this study was to explore how Inner Strength and its four dimensions are manifested in interviews in a group of middle-aged healthy women and men. Methods: Retrospective reflective interviews with middle-aged healthy women (n = 5) and men (n = 4) selected from a population study were content analysed deductively. Results: The following themes and their constituents were found in the respective dimensions of the Model of Inner Strength. Firmness: having a drive to act, being purposeful, having trust in one’s competence, and having a positive view of life. Connectedness: being in community, receiving and giving support, and, receiving and giving care. Creativity: changing unsatisfactory life situations, seeing new opportunities, and realizing dreams. Stretchability: balancing between options, and extending oneself. Conclusions: Expressions that were interpreted as belonging to Inner Strength could be referred the different dimensions of Inner Strength. The Model of Inner Strength is suitable for analysing Inner Strength among middle-aged men and women. The findings indicate that Inner Strength can be identified in human beings’ narratives if asked for.
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23
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Bean CG, Virtanen M, Westerlund H, Berg N, Hallqvist J, Hammarström A. Group activity participation at age 21 and depressive symptoms during boom and recession in Sweden: a 20-year follow-up. Eur J Public Health 2019; 29:475-481. [PMID: 30265293 DOI: 10.1093/eurpub/cky201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Christopher G Bean
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Marianna Virtanen
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Hugo Westerlund
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Noora Berg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Hallqvist
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anne Hammarström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Nyberg A, Rajaleid K, Westerlund H, Hammarström A. Does social and professional establishment at age 30 mediate the association between school connectedness and family climate at age 16 and mental health symptoms at age 43? J Affect Disord 2019; 246:52-61. [PMID: 30578946 DOI: 10.1016/j.jad.2018.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 11/08/2018] [Accepted: 12/16/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim was to use a theoretical framework developed by Bronfenbrenner in order to investigate if the association between school connectedness and family climate at age 16 and mental health symptoms at age 43 is mediated by social and professional establishment at age 30. METHODS Data were drawn from The Northern Swedish Cohort, a prospective population-based cohort. The present study included 506 women and 577 men who responded to questionnaires at age 16 (in year 1981), age 30 (in 1995) and age 43 (in 2008). Mediation was tested by fitting structural equation models (SEM) and estimating direct effects between proximal processes (school connectedness and family climate) and symptoms of depression and anxiety respectively, and indirect effects via social and professional establishment (professional activity, educational level, and civil status). RESULTS The standardised estimate for the direct path from school connectedness to depression was -0.147 (p = .000) and the indirect effect mediated by professional activity -0.017 (p = .011) and by civil status -0.020 (p = .002). The standardised direct effect between school connectedness and anxiety was -0.147 (p = .000) and the indirect effect mediated by civil status -0.018 (p = .005). Family climate was not significantly associated with the outcomes or mediators. LIMITATIONS Self-reported data; mental health measures not diagnostic; closed cohort; intelligence, personality and home situation before age 16 not accounted for. CONCLUSIONS Professional and social establishment in early adulthood appear to partially mediate the association between adolescent school connectedness and mental health symptoms in middle-age.
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Affiliation(s)
- Anna Nyberg
- Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden.
| | - Kristiina Rajaleid
- Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden
| | - Hugo Westerlund
- Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden
| | - Anne Hammarström
- Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden; Department of Public Health and Caring Sciences, Public Health, Uppsala University, SE-751 22 Uppsala, Sweden
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25
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Bean CG, Pingel R, Hallqvist J, Berg N, Hammarström A. Poor peer relations in adolescence, social support in early adulthood, and depressive symptoms in later adulthood—evaluating mediation and interaction using four-way decomposition analysis. Ann Epidemiol 2019; 29:52-59. [DOI: 10.1016/j.annepidem.2018.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 10/12/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
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26
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Birth size is not associated with depressive symptoms from adolescence to middle-age: results from the Northern Swedish Cohort study. J Dev Orig Health Dis 2018; 10:376-383. [PMID: 30378531 DOI: 10.1017/s2040174418000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Low birth weight has been shown to be related to increased risk of depression later in life - but the evidence is not conclusive. We examined the association of size at birth with repeatedly measured depressive symptoms in 947 individuals from the Northern Swedish Cohort, a community-based age-homogeneous cohort born in 1965, and followed with questionnaires between ages 16 and 43 (participation rate above 90% in all the surveys). Information on birth size was retrieved from archived birth records. Length of gestation was known for a subsample of 512 individuals (54%). We studied the association of birth weight and ponderal index with self-reported depressive symptoms at ages 16, 21, 30 and 43; with the life-course average of depressive symptoms score and with longitudinal trajectories of depressive symptoms retrieved by latent class growth analysis. Socioeconomic background, mental illness or alcohol problems of a parent, exposure to social adversities in adolescence and prematurity were accounted for in the analyses. We did not find any relationship between weight or ponderal index at birth and our measure of depressive symptoms between ages 16 and 43 in a series of different analyses. Adjustment for length of gestation did not alter the results. We conclude that size at birth is not associated with later-life depressive symptoms score in this cohort born in the mid-1960s in Sweden. The time and context need to be taken into consideration in future studies.
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Almquist YB, Landstedt E, Hammarström A. Associations between social support and depressive symptoms: social causation or social selection-or both? Eur J Public Health 2018; 27:84-89. [PMID: 28177442 DOI: 10.1093/eurpub/ckw120] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ylva B Almquist
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Evelina Landstedt
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Norrland University Hospital, Umeå, Sweden
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Norrland University Hospital, Umeå, Sweden
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Wiklund M, Ahlgren C, Hammarström A. Constructing respectability from disfavoured social positions: exploring young femininities and health as shaped by marginalisation and social context. A qualitative study in Northern Sweden. Glob Health Action 2018; 11:1519960. [PMID: 30270777 PMCID: PMC6197021 DOI: 10.1080/16549716.2018.1519960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Gender, class and living conditions shape health and illness. However, few studies have investigated constructs of femininity in relation to health and living conditions among young women who are unemployed and marginalised at an early age. OBJECTIVE The aim of this research was to elucidate constructs of femininities in relation to structuring living conditions and expressions of health in Northern Swedish women. The time period of interest was the transition from unemployed teenagers to young adults in a social context of high unemployment and societal change across the critical 'school-to-work-transition' period of the life course. METHODS Qualitative content analysis was used to analyse data from repeated interviews with unemployed young women, aged 16-33 years, during the 1980s and 1990s. These longitudinal interviews were part of a cohort study in a 'remote' municipality in Northern Sweden that began in 1981. All girls who were not in education, employment, or training were selected for interview. An inductive analysis phase was followed by a theoretically informed phase. The contextual frame is the Nordic welfare-state model and the 'caring state' with its particular focus on basic and secondary education, and women's participation in the labour market. This focus paralleled high rates of youth unemployment in northern Sweden during the study period. RESULTS The results are presented as the theme of 'constructing respectability from disfavoured social positions'. Within this theme, and framed by dominant norms of patriarchal femininity, we explored the constructs of normative and altruistic, norm-breaking, and troubled femininity. CONCLUSIONS Gender-sensitive interventions are needed to strengthen young women's further education and positions in the labour market and to preventing exposure to violence. More research on health experiences related to the multitude of constructs of femininities in various social contexts and across the life course is needed to help design and implement such interventions.
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Affiliation(s)
- Maria Wiklund
- a Department of Community Medicine and Rehabilitation, Physiotherapy , Umeå University , Umeå , Sweden.,b Department of Public Health and Caring Sciences, Public Health , Uppsala University , Uppsala , Sweden
| | - Christina Ahlgren
- b Department of Public Health and Caring Sciences, Public Health , Uppsala University , Uppsala , Sweden
| | - Anne Hammarström
- b Department of Public Health and Caring Sciences, Public Health , Uppsala University , Uppsala , Sweden
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Prevailing over Adversity: Factors Counteracting the Long-Term Negative Health Influences of Social and Material Disadvantages in Youth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091842. [PMID: 30150519 PMCID: PMC6164040 DOI: 10.3390/ijerph15091842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 01/28/2023]
Abstract
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.
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Jonsson F, Sebastian MS, Hammarström A, Gustafsson PE. 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 analysis. Health Place 2018; 52:127-134. [PMID: 29886129 DOI: 10.1016/j.healthplace.2018.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/03/2018] [Accepted: 05/29/2018] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Frida Jonsson
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-90187 Umeå, Sweden.
| | - Miguel San Sebastian
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-90187 Umeå, Sweden.
| | - Anne Hammarström
- Department of Public Health and Caring Sciences, Uppsala University, SE-751 22 Uppsala, Sweden.
| | - Per E Gustafsson
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-90187 Umeå, Sweden.
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Landstedt E, Hammarström A, Fairweather-Schmidt AK, Wade T. Associations between adolescent risk for restrictive disordered eating and long-term outcomes related to somatic symptoms, body mass index, and poor well-being. Br J Health Psychol 2018; 23:496-518. [DOI: 10.1111/bjhp.12301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 01/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Anne Hammarström
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | | | - Tracey Wade
- School of Psychology; Flinders University; Adelaide South Australia Australia
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Trajectories of musculoskeletal pain from adolescence to middle age: the role of early depressive symptoms, a 27-year follow-up of the Northern Swedish Cohort. Pain 2017; 159:67-74. [DOI: 10.1097/j.pain.0000000000001065] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Byhamre ML, Gustafsson PE, Jansson JH, Wennberg M, Hammarström A, Wennberg P. Snus use during the life-course and risk of the metabolic syndrome and its components. Scand J Public Health 2017; 45:733-740. [DOI: 10.1177/1403494817706631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Marja Lisa Byhamre
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Sweden
| | - Per E Gustafsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Sweden
| | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Sweden
| | - Anne Hammarström
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Sweden
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Nygren K, Hammarström A, Rolandsson O. Binge drinking and total alcohol consumption from 16 to 43 years of age are associated with elevated fasting plasma glucose in women: results from the northern Swedish cohort study. BMC Public Health 2017; 17:509. [PMID: 28592314 PMCID: PMC5463312 DOI: 10.1186/s12889-017-4437-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 05/15/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Studies have indicated that moderate alcohol consumption is associated with lower incidence of diabetes in women. However, not only the amount but also the drinking pattern could be of importance when assessing the longitudinal relation between alcohol and glucose. Also, there is a lack of studies on alcohol use beginning in adolescence on adult glucose levels. The aim was to examine the association between total alcohol consumption and binge drinking between ages 16 and 43 and fasting plasma glucose at age 43. METHODS Data were retrieved from a 27-year prospective cohort study, the Northern Swedish Cohort. In 1981, all 9th grade students (n = 1083) within a municipality in Sweden were invited to participate. There were re-assessments at ages 18, 21, 30 and 43. This particular study sample consisted of 897 participants (82.8%). Fasting plasma glucose (mmol/L) was measured at a health examination at age 43. Total alcohol consumption (in grams) and binge drinking were calculated from alcohol consumption data obtained from questionnaires. RESULTS Descriptive analyses showed that men had higher levels of fasting plasma glucose as compared to women. Men also reported higher levels of alcohol consumption and binge drinking behavior. Linear regressions showed that total alcohol consumption in combination with binge drinking between ages 16 and 43 was associated with elevated fasting plasma glucose at age 43 in women (beta = 0.14, p = 0.003) but not in men after adjustment for BMI, hypertension and smoking at age 43. CONCLUSIONS Our findings indicate that reducing binge drinking and alcohol consumption among young and middle-aged women with the highest consumption might be metabolically favorable for their future glucose metabolism.
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Affiliation(s)
- Karina Nygren
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE 90187 Sweden
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE 90187 Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Olov Rolandsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE 90187 Sweden
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Norström F, Janlert U, Hammarström A. Is unemployment in young adulthood related to self-rated health later in life? Results from the Northern Swedish cohort. BMC Public Health 2017; 17:529. [PMID: 28558793 PMCID: PMC5450391 DOI: 10.1186/s12889-017-4460-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many studies have reported that unemployment has a negative effect on health. However, little is known about the long-term effect for those who become unemployed when they are young adults. Our aim was to examine how unemployment is related to long-term self-rated health among 30 year olds, with an emphasis on how health differs in relation to education level, marital status, previous health, occupation, and gender. METHODS In the Northern Swedish Cohort, 1083 teenagers (~16 years old) were originally invited in 1981. Of these, 1001 participated in the follow-up surveys in 1995 and 2007. In our study, we included participants with either self-reported unemployment or activity in the labor force during the previous three years in the 1995 follow-up so long as they had no self-reported unemployment between the follow-up surveys. Labor market status was studied in relation to self-reported health in the 2007 follow-up. Information from the 1995 follow-up for education level, marital status, self-reported health, and occupation were part of the statistical analyses. Analyses were stratified for these variables and for gender. Analyses were performed with logistic regression, G-computation, and a method based on propensity scores. RESULTS Poor self-rated health in 2007 was reported among 43 of the 98 (44%) unemployed and 159 (30%) of the 522 employed subjects. Unemployment had a long-term negative effect on health (odds ratio with logistic regression 1.74 and absolute difference estimates of 0.11 (G-computation) and 0.10 (propensity score method)). At the group level, the most pronounced effects on health were seen in those with upper secondary school as their highest education level, those who were single, low-level white-collar workers, and women. CONCLUSIONS Even among those becoming unemployed during young adulthood, unemployment is related to a negative long-term health effect. However, the effect varies among different groups of individuals. Increased emphasis on understanding the groups for whom unemployment is most strongly related to ill health is important for future research so that efforts can be put towards those with the biggest need. Still, our results can be used as the basis for deciding which groups should be prioritized for labor-market interventions.
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Affiliation(s)
- Fredrik Norström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE, 901 87, Umeå, Sweden.
| | - Urban Janlert
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE, 901 87, Umeå, Sweden
| | - Anne Hammarström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Jonsson F, Sebastian MS, Hammarström A, Gustafsson PE. Intragenerational social mobility and functional somatic symptoms in a northern Swedish context: analyses of diagonal reference models. Int J Equity Health 2017; 16:1. [PMID: 28057005 PMCID: PMC5217297 DOI: 10.1186/s12939-016-0499-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/13/2016] [Indexed: 11/10/2022] Open
Abstract
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 Luleå, 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.
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Affiliation(s)
- Frida Jonsson
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, Umeå, SE-901 85, Sweden.
| | - Miguel San Sebastian
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, Umeå, SE-901 85, Sweden
| | - Anne Hammarström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Per E Gustafsson
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, Umeå, SE-901 85, Sweden
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Does contextual unemployment matter for health status across the life course? A longitudinal multilevel study exploring the link between neighbourhood unemployment and functional somatic symptoms. Health Place 2016; 43:113-120. [PMID: 27997864 DOI: 10.1016/j.healthplace.2016.11.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/27/2016] [Accepted: 11/17/2016] [Indexed: 11/22/2022]
Abstract
This study examines whether neighbourhood unemployment is related to functional somatic symptoms, independently of the individual employment, across the life course and at four specific life course periods (age 16, 21, 30 and 42). Self-reported questioner data was used from a 26-year prospective Swedish cohort (n=1010) with complementary neighbourhood register data. A longitudinal and a set of age-specific cross-sectional hierarchal linear regressions was carried out. The results suggest that living in a neighbourhood with high unemployment has implications for residents' level of functional somatic symptoms, regardless of their own unemployment across time, particularly at age 30.
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Vancea M, Utzet M. How unemployment and precarious employment affect the health of young people: A scoping study on social determinants. Scand J Public Health 2016; 45:73-84. [DOI: 10.1177/1403494816679555] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: The impact of unemployment and precarious employment on the health of young people is not well understood. However, according to social causation, higher socio-economic positions and thus better working conditions are beneficial to health in general. We tried to synthesize the results of studies that test this hypothesis in the case of young people. Methods: We conducted a scoping study mapping all the academic articles published in the period 2006–2016 in Europe. The literature was searched in PubMed/Medline, Science Direct, Web of Science and Scopus. Results: We identified 1770 studies, of which only 46 met the inclusion criteria. There are more studies that focus on the relationship between unemployment and health than between precarious employment and health (28 and 16, respectively). The vast majority of the studies (44) found support for the social causation hypothesis, the most common health outcomes being mental health disorders, health risk behaviour, poor quality of life and occupational injuries. The causal mechanisms behind this association relied mainly on the life-course perspective, the breadwinner model, and the lack of social and economic benefits provided by standard employment. Conclusions:There is evidence that young people are especially vulnerable to health problems when unemployed or working in precarious conditions. Active labour market and training programmes, inclusive social security measures, improved working conditions and targeted health programmes are important for addressing this vulnerability. Further research should strive to enhance the causal model by including a gender perspective, longitudinal data, more indicators on precariousness and third factor explanations.
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Affiliation(s)
- Mihaela Vancea
- Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Center for Scientific Research and Technological Development in Social Sciences and Humanities, Universidad de la Frontera, Temuco, Chile
| | - Mireia Utzet
- Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Universitat Autònoma de Barcelona, Facultat de Medicina, GRAAL-Biostatistics Unit, Bellaterra, Spain
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Landstedt E, Brydsten A, Hammarström A, Virtanen P, Almquist YB. The role of social position and depressive symptoms in adolescence for life-course trajectories of education and work: a cohort study. BMC Public Health 2016; 16:1169. [PMID: 27863527 PMCID: PMC5116205 DOI: 10.1186/s12889-016-3820-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/04/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While a vast amount of studies confirm the social reproduction of class and status from one generation to the next, less is known about the role of health in the child generation for these processes. Research has shown that particularly mental distress in adolescence is important for future life chances. This study aimed to examine the importance of parental socioeconomic position and depressive symptoms in youth for life-course trajectories of education and labour market attachment among men and women. METHODS Based on four waves of questionnaire data from the Northern Swedish Cohort (n = 1,001), consisting of individuals born in 1965, three steps of gender-separate analyses were undertaken. First, the individual trajectories of education and labour market attachment from age 18 to 42 were mapped through sequence analysis. Second, cluster analysis was used to identify typical trajectories. Third, two indicators of parental socioeconomic position - occupational class and employment status - and depressive symptoms at age 16 were used in multinomial regression analyses to predict adult life-course trajectories. RESULTS Four typical trajectories were identified for men, of which three were characterised by stable employment and various lengths of education, and the fourth reflected a more unstable situation. Among women, five trajectories emerged, characterised by more instability compared to men. Low parental occupational class and unemployment were significantly associated with a higher risk of ending up in less advantaged trajectories for men while, for women, this was only the case for occupational class. Youth levels of depressive symptoms did not significantly differ across the trajectories. CONCLUSIONS This study found support for the intergenerational reproduction of social position, particularly when measured in terms of parental occupational class. Youth depressive symptoms did not show clear differences across types of trajectories, subsequently impeding such symptoms to trigger any selection processes. While this could be a consequence of the specific framework of the current study, it may also suggest that depressive symptoms in youth are not a root cause for the more complex processes through which how social position develops across life. The possible impact of welfare and labour market policies is discussed.
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Affiliation(s)
- Evelina Landstedt
- Department of Public Health and Clincial Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anna Brydsten
- Department of Public Health and Clincial Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- Department of Public Health and Clincial Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Pekka Virtanen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Ylva B. Almquist
- Centre for Health Equity Studies (CHESS) Stockholm University/Karolinska Institutet, Stockholm, Sweden
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Landstedt E, Almquist YB, Eriksson M, Hammarström A. Disentangling the directions of associations between structural social capital and mental health: Longitudinal analyses of gender, civic engagement and depressive symptoms. Soc Sci Med 2016; 163:135-43. [PMID: 27423294 DOI: 10.1016/j.socscimed.2016.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/30/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Evelina Landstedt
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Norrland University Hospital, SE-901 85 Umeå, Sweden.
| | - Ylva B Almquist
- Centre for Health Equity Studies (CHESS), Stockholm University, Karolinska Institutet, SE-106 91 Stockholm, Sweden
| | - Malin Eriksson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Norrland University Hospital, SE-901 85 Umeå, Sweden
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Norrland University Hospital, SE-901 85 Umeå, Sweden
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Landstedt E, Harryson L, Hammarström A. Changing housework, changing health? A longitudinal analysis of how changes in housework are associated with functional somatic symptoms. Int J Circumpolar Health 2016; 75:31781. [PMID: 27369590 PMCID: PMC4930552 DOI: 10.3402/ijch.v75.31781] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 11/22/2022] Open
Abstract
AIM The aim of this study was to analyse how changes in housework over the course of adulthood are related to somatic health in Swedish men and women. METHODS Data were drawn from 2 waves of the Northern Swedish Cohort Study, response rate 94.3%, N=1,001. A subsample of cohabiting individuals was selected (n=328 women, 300 men). Outcome variable was functional somatic symptoms (FSS) at age 42. Associations were assessed in multivariate general linear models with adjustment for confounders and somatic health at age 30. RESULTS Housework is primarily performed by women, and women's responsibility for and performance of housework increased from ages 30 to 42. These changes were associated with elevated levels of FSS at age 42 in women. Men reported considerably lower responsibility for and performed less housework compared with women, the load of housework for men does not change substantially from ages 30 to 42 and no associations with FSS were identified. CONCLUSIONS The gendered division of housework means that women are particularly exposed to a heavy workload. Women's responsibility for and performance of housework increase between ages 30 and 42 and this threatens to be embodied in the form FSS. We conclude that housework should be considered an important source of stress in addition to that from waged work and that a deeper understanding of the links between housework and health requires a gender theoretical analysis.
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Affiliation(s)
- Evelina Landstedt
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden;
| | - Lisa Harryson
- Department of Sociology, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Jonsson F, San Sebastian M, Strömsten LMJ, Hammarström A, Gustafsson PE. Life Course Pathways of Adversities Linking Adolescent Socioeconomic Circumstances and Functional Somatic Symptoms in Mid-Adulthood: A Path Analysis Study. PLoS One 2016; 11:e0155963. [PMID: 27214206 PMCID: PMC4877101 DOI: 10.1371/journal.pone.0155963] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/07/2016] [Indexed: 12/12/2022] Open
Abstract
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 Luleå, 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/non-manual) 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.
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Affiliation(s)
- Frida Jonsson
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- * E-mail:
| | - Miguel San Sebastian
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Lotta M. J. Strömsten
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Per E. Gustafsson
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Virtanen P, Lintonen T, Westerlund H, Nummi T, Janlert U, Hammarström A. Unemployment in the teens and trajectories of alcohol consumption in adulthood. BMJ Open 2016; 6:e006430. [PMID: 27016242 PMCID: PMC4809082 DOI: 10.1136/bmjopen-2014-006430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/04/2015] [Accepted: 10/21/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The unemployed are assumed to adopt unhealthy behaviours, including harmful use of alcohol. This study sought to elucidate the relations between unemployment before age 21 years and consumption of alcohol from 21 to 42 years. The design was based on the conception of youth as a sensitive period for obtaining 'drinking scars' that are visible up to middle age. SETTING The Northern Swedish Cohort Study has followed up a population sample from 1981 to 2007 with five surveys. PARTICIPANTS All pupils (n=1083) attending the last year of compulsory school in Luleå participated in the baseline survey in classrooms, and 1010 of them (522 men and 488 women) participated in the last follow-up survey that was conducted at classmate reunions or by post or by phone. OUTCOME MEASURE The trajectory of alcohol consumption from 21 to 43 years, obtained with latent class growth analyses, was scaled. RESULTS Men were assigned to five and women to three consumption trajectories. The trajectory membership was regressed on accumulation of unemployment from 16 to 21 years, with multinomial logistic regression analyses. The trajectory of moderate consumption was preceded by lowest exposure to unemployment in men and in women. With reference to this, the relative risk ratios for high-level trajectory groups were 3.49 (1.25 to 9.79) in men and 1.41 (0.74 to 2.72) in women, but also the trajectories of low-level consumption were more probable (relative risk ratio 3.18 (1.12 to 9.02) in men and 2.41 (1.24 to 4.67) in women). CONCLUSIONS High-level alcohol consumption throughout adulthood is, particularly among men, partly due to 'scars' from youth unemployment, particularly in men, but there are also groups of men and women where unemployment in the teens predicts a trajectory of low consumption.
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Affiliation(s)
- Pekka Virtanen
- University of Tampere, Institute for Advanced Social Research and School of Health Sciences, Tampere, Finland
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tomi Lintonen
- The Finnish Foundation for Alcohol Studies, Helsinki, Finland
| | - Hugo Westerlund
- University of Stockholm, Stress Research Centre, Stockholm, Sweden
| | - Tapio Nummi
- University of Tampere, School of Health Sciences, Tampere, Finland
| | - Urban Janlert
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Brydsten A, Hammarström A, San Sebastian M. The impact of economic recession on the association between youth unemployment and functional somatic symptoms in adulthood: a difference-in-difference analysis from Sweden. BMC Public Health 2016; 16:230. [PMID: 26944536 PMCID: PMC4779244 DOI: 10.1186/s12889-016-2917-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/01/2016] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Anna Brydsten
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
| | - Miguel San Sebastian
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
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Harryson L, Aléx L, Hammarström A. "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 resignation. BMC Public Health 2016; 16:224. [PMID: 26944701 PMCID: PMC4779260 DOI: 10.1186/s12889-016-2920-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/02/2016] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Lisa Harryson
- />Department of Sociology, Umeå University, 901 87 Umeå, Sweden
| | - Lena Aléx
- />Department of Nursing, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- />Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Virtanen P, Hammarström A, Janlert U. Children of boom and recession and the scars to the mental health--a comparative study on the long term effects of youth unemployment. Int J Equity Health 2016; 15:14. [PMID: 26792092 PMCID: PMC4720998 DOI: 10.1186/s12939-016-0305-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 01/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Earlier research shows that there is an association between unemployment and poor mental health, and that recovery from the damages to mental health obtained during unemployment remains incomplete over a long period of time. The present study relates this 'mental health scarring' to the trade cycle, exploring if those exposed to youth unemployment during boom differ from those exposed during recession with respect to mental health in the middle age. METHODS The sample consists of two cohorts from the same industrial town in Northern Sweden: the cohort born in 1965 and the cohort born in 1973 included all pupils attending the last grade of compulsory school, respectively, in 1981 and in 1989. Their depressiveness and anxiousness were assessed by questionnaires at age 21 and again at age 43/39. Mental health at follow-up was related to exposure to unemployment during age years 21-25. Statistical significance of the cohort*exposure interactions from binary logistic regression analyses were used to assess the cohort differences in the mental health between Cohort65 and Cohort73, entering the labour market, respectively, during a boom and a recession. RESULTS Compared to the unexposed, high exposure to unemployment at the age from 21 to 25 was associated to increased probability of poor mental health in the middle age in both in Cohort65 (odds ratio 2.19 [1.46-3.30] for anxiousness and 1.85 [1.25-2.74]for depressiveness) and in Cohort73 (odds ratio 2.13 [1.33-3.39] for anxiousness and 1.38 [0.89-2.14] for depressiveness). The differences between the cohorts also turned out as statistically non-significant. CONCLUSIONS The scars of unemployment exposure onto future health seem to be rather insensitive to economic trades. Thus, at the population level this would mean that the long-term health costs that can be attributed to youth unemployment are more widespread in the generation that suffers of recession around the entry to the work life.
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Affiliation(s)
- Pekka Virtanen
- University of Tampere, School of Health Sciences, Tampere, 33014, Finland. .,Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, Umeå, Sweden.
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, Umeå, Sweden
| | - Urban Janlert
- Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden
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Hammarström A, Westerlund H, Kirves K, Nygren K, Virtanen P, Hägglöf B. Addressing challenges of validity and internal consistency of mental health measures in a 27- year longitudinal cohort study - the Northern Swedish Cohort study. BMC Med Res Methodol 2016; 16:4. [PMID: 26743433 PMCID: PMC4705757 DOI: 10.1186/s12874-015-0099-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 12/07/2015] [Indexed: 02/02/2023] Open
Abstract
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 of 43 (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.
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Affiliation(s)
- Anne Hammarström
- Department of Public Health and Clinical Medicine, Unit of Social Medicine, Umeå University, 901 85, Umeå, Sweden.
| | - Hugo Westerlund
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Kaisa Kirves
- School of Social Sciences and Humanities, Psychology, University of Tampere, Tampere, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Karina Nygren
- Department of Public Health and Clinical Medicine, Unit of Social Medicine, Umeå University, 901 85, Umeå, Sweden
| | - Pekka Virtanen
- Department of Public Health and Clinical Medicine, Unit of Social Medicine, Umeå University, 901 85, Umeå, Sweden.,School of Health Sciences, University of Tampere, Tampere, Finland
| | - Bruno Hägglöf
- Department of Clinical Sciences, Division of Child and Adolescent Psychiatry, Umeå University, Umeå, Sweden
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Strandh M, Nilsson K, Nordlund M, Hammarström A. Do open youth unemployment and youth programs leave the same mental health scars?--Evidence from a Swedish 27-year cohort study. BMC Public Health 2015; 15:1151. [PMID: 26589399 PMCID: PMC4654869 DOI: 10.1186/s12889-015-2496-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent findings suggest that the mental health costs of unemployment are related to both short- and long-term mental health scars. The main policy tools for dealing with young people at risk of labor market exclusion are Active Labor Market Policy programs for youths (youth programs). There has been little research on the potential effects of participation in youth programs on mental health and even less on whether participation in such programs alleviates the long-term mental health scarring caused by unemployment. This study compares exposure to open youth unemployment and exposure to youth program participation between ages 18 and 21 in relation to adult internalized mental health immediately after the end of the exposure period at age 21 and two decades later at age 43. METHODS The study uses a five wave Swedish 27-year prospective cohort study consisting of all graduates from compulsory school in an industrial town in Sweden initiated in 1981. Of the original 1083 participants 94.3% of those alive were still participating at the 27-year follow up. Exposure to open unemployment and youth programs were measured between ages 18-21. Mental health, indicated through an ordinal level three item composite index of internalized mental health symptoms (IMHS), was measured pre-exposure at age 16 and post exposure at ages 21 and 42. Ordinal regressions of internalized mental health at ages 21 and 43 were performed using the Polytomous Universal Model (PLUM). Models were controlled for pre-exposure internalized mental health as well as other available confounders. RESULTS Results show strong and significant relationships between exposure to open youth unemployment and IMHS at age 21 (OR = 2.48, CI = 1.57-3.60) as well as at age 43 (OR = 1.71, CI = 1.20-2.43). No such significant relationship is observed for exposure to youth programs at age 21 (OR = 0.95, CI = 0.72-1.26) or at age 43 (OR = 1.23, CI = 0.93-1.63). CONCLUSIONS A considered and consistent active labor market policy directed at youths could potentially reduce the short- and long-term mental health costs of youth unemployment.
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Affiliation(s)
- Mattias Strandh
- Department of Social Work, Umeå University, SE-90187, Umeå, Sweden. .,Centre for Research on Child and Adolescent Mental Health, Karlstad University, SE-651 88, Karlstad, Sweden.
| | - Karina Nilsson
- Department of Sociology, Umeå University, SE-90187, Umeå, Sweden.
| | | | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Umeå University, SE-90187, Umeå, Sweden.
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San Sebastian M, Hammarström A, Gustafsson PE. Socioeconomic inequalities in functional somatic symptoms by social and material conditions at four life course periods in Sweden: a decomposition analysis. BMJ Open 2015; 5:e006581. [PMID: 26319773 PMCID: PMC4554899 DOI: 10.1136/bmjopen-2014-006581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Socioeconomic inequalities in health are deemed a worldwide public health problem, but current research is lacking on key points including determinants of socioeconomic differences in health, and not the least variations of these determinants over the life course. Using a 26-year prospective Swedish community-based cohort, we aim at decomposing socioeconomic inequalities in functional somatic symptoms by social and material life circumstances, at 4 periods of the life course. DESIGN Repeated cross-sectional study. SETTING Participants came from the Northern Swedish Cohort (n=1001), who completed questionnaires about occupational class, social and material living conditions, and symptoms at ages 16, 21, 30 and 42. Socioeconomic inequalities were estimated and decomposed using the Blinder-Oaxaca decomposition analysis. RESULTS Inequalities in symptoms between blue-collar and white-collar socioeconomic groups increased along the life course in the sample. In the decomposition analysis, a high proportion of the gap between socioeconomic groups could be explained by social and material living conditions at ages 16 (84% explained), 30 (45%) and 42 (68%), but not at age 21. Specific social (parental illness at age 16 and violence at ages 30 and 42) and material (parental unemployment at age 16, and own unemployment and financial strain at ages 30 and 42) factors contributed jointly to the health gaps. CONCLUSIONS Socioeconomic inequalities in functional somatic symptoms increased along the life course in this Swedish cohort. A considerable portion of the social gaps in health was explained by concurrent social and material conditions, and the importance of specific adversities was dependent on the life course stage. Our findings suggest that socioeconomic inequalities in functional somatic symptoms may be reduced by addressing both social and material living conditions of disadvantaged families, and also that the life course stage needs to be taken into consideration.
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Affiliation(s)
- Miguel San Sebastian
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Per E Gustafsson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
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Rajaleid K, Nummi T, Westerlund H, Virtanen P, Gustafsson PE, Hammarström A. Social adversities in adolescence predict unfavourable trajectories of internalized mental health symptoms until middle age: results from the Northern Swedish Cohort. Eur J Public Health 2015; 26:23-9. [DOI: 10.1093/eurpub/ckv150] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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