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Möller J, Lindholm E, Fredlund P, Vaez M, Liang Y, Laflamme L. Trends in intentional and unintentional poisonings among older adults - A national register-based study in Sweden. BMC Geriatr 2023; 23:296. [PMID: 37189030 DOI: 10.1186/s12877-023-03973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Among older people intentional poisoning outnumber unintentional ones. While there are indications that time trends differ by poisoning intent, studies are scarce. We assessed how the annual prevalence of intentional and unintentional poisoning changed over time, overall and by demographic groups. METHODS We conducted a national open cohort study of individuals aged 50-100 years, resident in Sweden during 2005-2016. Individuals were followed up in population-based registers for their demographic and health attributes from 2006-2016. Annual prevalence of hospitalization and death by poisoning intent (unintentional vs. intentional or undetermined; ICD-10 definitions) were compiled for the categories of four demographic attributes (age, sex, marital status, and birth cohort "baby boomers"). The time trends were assessed by multinomial logistic regression with year as an independent variable. RESULTS The annual overall prevalence of hospitalization and death by intentional poisonings consistently exceeded that of unintentional poisonings. There was a significant downward trend in intentional poisonings but not in unintentional ones. This difference in trends also applied when considering men and women separately, married and unmarried people, the young-old individuals (but not the older- or oldest-old ones), and the baby boomers and non-baby boomers. The largest demographic differences within intent were found between married and unmarried people, and the smallest one between men and women. CONCLUSION As expected, the annual prevalence of intentional poisonings considerably exceed that of unintentional ones among Swedish older people. The recent trends reveal a significant reduction of intentional poisonings, consistent across a range of demographic attributes. The scope for action regarding this preventable cause of mortality and morbidity remains considerable.
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Affiliation(s)
- J Möller
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GH, 171 77, Stockholm, Sweden
| | - E Lindholm
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GH, 171 77, Stockholm, Sweden.
| | - P Fredlund
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GH, 171 77, Stockholm, Sweden
| | - M Vaez
- Department of Living Conditions and Lifestyles, The Public Health Agency of Sweden, Stockholm, Sweden
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Y Liang
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GH, 171 77, Stockholm, Sweden
| | - L Laflamme
- Department of Global Public Health, Karolinska Institutet, K9 Global Folkhälsa, K9 GH, 171 77, Stockholm, Sweden
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Laflamme L, Lindholm E, Airaksinen E, Vaez M, Möller J. 410 - Tendances des hospitalisations et décès par empoisonnement chez les personnes âgées. Étude nationale populationnelle en Suède. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bergqvist E, Probert-Lindström S, Fröding E, Palmqvist-Öberg N, Ehnvall A, Sunnqvist C, Sellin T, Vaez M, Waern M, Westrin Å. Health care utilisation two years prior to suicide in Sweden: a retrospective explorative study based on medical records. BMC Health Serv Res 2022; 22:664. [PMID: 35581647 PMCID: PMC9115926 DOI: 10.1186/s12913-022-08044-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/28/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Previous literature has suggested that identifying putative differences in health care seeking patterns before death by suicide depending on age and gender may facilitate more targeted suicide preventive approaches. The aim of this study is to map health care utilisation among individuals in the two years prior to suicide in Sweden in 2015 and to examine possible age and gender differences. METHODS Design: A retrospective explorative study with a medical record review covering the two years preceding suicide. SETTING All health care units located in 20 of Sweden's 21 regions. PARTICIPANTS All individuals residing in participating regions who died by suicide during 2015 (n = 949). RESULTS Almost 74% were in contact with a health care provider during the 3 months prior to suicide, and 60% within 4 weeks. Overall health care utilisation during the last month of life did not differ between age groups. However, a higher proportion of younger individuals (< 65 years) were in contact with psychiatric services, and a higher proportion of older individuals (≥ 65 years) were in contact with primary and specialised somatic health care. The proportion of women with any type of health care contact during the observation period was larger than the corresponding proportion of men, although no gender difference was found among primary and specialised somatic health care users within four weeks and three months respectively prior to suicide. CONCLUSION Care utilisation before suicide varied by gender and age. Female suicide decedents seem to utilise health care to a larger extent than male decedents in the two years preceding death, except for the non-psychiatric services in closer proximity to death. Older adults seem to predominantly use non-psychiatric services, while younger individuals seek psychiatric services to a larger extent.
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Affiliation(s)
- Erik Bergqvist
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden.
- Psychiatric In-Patient Clinic, Hallands Sjukhus Varberg, Region Halland, 432 81, Varberg, Sweden.
| | - Sara Probert-Lindström
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, 221 85, Lund, Sweden
| | - Elin Fröding
- School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, 551 11, Jönköping, Sweden
- Region Jonköpings Län, Jönköping, Sweden
| | - Nina Palmqvist-Öberg
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, 221 85, Lund, Sweden
| | - Anna Ehnvall
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, 413 45, Gothenburg, Sweden
- Psychiatric Out-Patient Clinic, Region Halland, 432 43, Varberg, Sweden
| | - Charlotta Sunnqvist
- Faculty of Health and Society, Department of Care Science, Malmö University, 214 28, Malmö, Sweden
| | - Tabita Sellin
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, 701 82, Örebro, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, 413 45, Gothenburg, Sweden
- Psychosis Clinic, Sahlgrenska University Hospital, Region Västra Götaland, 431 30, Mölndal, Sweden
| | - Åsa Westrin
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Baravägen 1, 221 85, Lund, Sweden
- Office of Psychiatry and Habilitation, Region Skåne, 221 85, Lund, Sweden
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Laflamme L, Vaez M, Lundin K, Sengoelge M. Prevention of suicidal behavior in older people: A systematic review of reviews. PLoS One 2022; 17:e0262889. [PMID: 35077476 PMCID: PMC8789110 DOI: 10.1371/journal.pone.0262889] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/09/2022] [Indexed: 01/08/2023] Open
Abstract
Older people have the highest rates of suicide, yet the evidence base on effective suicide preventions in late-life is limited. This systematic review of reviews aims to synthesize data from existing reviews on the prevention and/or reduction of suicide behavior in late-life and evidence for effectiveness of interventions. A systematic database search was conducted in eight electronic databases from inception to 4/2020 for reviews targeting interventions among adults ≥ 60 to prevent and/or reduce suicide, suicide attempt, self-harm and suicidal ideation. Four high quality reviews were included and interventions categorized as pharmacological (antidepressant use: 239 RCTs, seven observational studies) and behavioral (physical activity: three observational studies, and multifaceted primary-care-based collaborative care for depression screening and management: four RCTs). The 2009 antidepressant use review found significant risk reduction for suicide attempt/self-harm (OR = 0.06, 95% CI 0.01-0.58) and suicide ideation (OR = 0.39, 95% CI 0.18-0.78) versus placebo. The 2015 review found an increased risk of attempts with antidepressants versus no treatment (RR = 1.18, 95% CI 1.10-1.27) and no statistically significant change in suicides versus no treatment (RR = 1.06, 95% CI 0.68-1.66) or ideation versus placebo (OR = 0.52, 95% CI 0.14-1.94). Protective effects were found for physical activity on ideation in 2 out of 3 studies when comparing active versus inactive older people. Collaborative care demonstrated significantly less attempts/ideation (OR = 0.80, 95% CI 0.68-0.94) in intervention group versus usual care. The results of this review of reviews find the evidence inconclusive towards use of antidepressants for the prevention of suicidal behavior in older people, thus monitoring is required prior to start, dosage change or cessation of antidepressants. Evidence to date supports physical activity and collaborative management for reduction of suicide ideation, but additional trials are required for a meta-analysis. To build on these findings, continued high-quality research is warranted to evaluate the effectiveness of interventions in late life.
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Affiliation(s)
- Lucie Laflamme
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Insurance Medicine, Stockholm, Sweden
| | - Karima Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mathilde Sengoelge
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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5
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Probert-Lindström S, Vaez M, Fröding E, Ehnvall A, Sellin T, Ambrus L, Bergqvist E, Palmqvist-Öberg N, Waern M, Westrin Å. Utilization of psychiatric services prior to suicide- a retrospective comparison of users with and without previous suicide attempts. Arch Suicide Res 2021; 27:401-414. [PMID: 34821208 DOI: 10.1080/13811118.2021.2006101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim was to investigate psychiatric health care utilization two years before death by suicide among individuals with previous suicide attempts (PSA) compared with those without (NSA). METHOD A retrospective population-based cohort study was conducted including 484 individuals who died by suicide in Sweden in 2015 and were in contact with psychiatric services within the two years preceding death, identified through the Cause of Death register. Data on psychiatric health care two years before death, including suicide attempts according to notes in the medical record was used. Associations between having at least one PSA vs. NSA and health care utilization were estimated as odds ratios (OR) with 95% confidence intervals (CI) by logistic regression analyses. RESULTS Of the 484 individuals included, 51% had PSA. Those with PSA were more likely than NSA to have received a psychiatric diagnosis [OR 1.96 (CI 95% 1.17-3.30)], to have ongoing psychotropic medication [OR 1.96 (CI 95% 1.15-3.36)] and to have been absent from appointments during the last three months [1.97 (1.25-3.13)]. In addition, elevated suicide risk was more often noted in the psychiatric case records of those with a PSA than those without [OR 2.17 (CI 95% 1.24-3.79)]. CONCLUSION The results underline the importance of improved suicide risk assessment as well as thorough diagnostic assessment and when indicated, psychiatric treatment as suicide preventive interventions regardless of PSA. Furthermore, the larger proportion of absence from appointments in individuals with PSA may indicate a need of improved alliance between psychiatric care providers and individuals with PSA.HIGHLIGHTSBeing assessed with elevated suicide risk was more common among those with previous attempt/s (PSA).One-fifth of all with no previous attempt (NSA) had no psychiatric diagnosis, compared to one in ten in those with PSA.Receiving psychotropic medication was more common among those with PSA.
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Winzer R, Vaez M, Lindberg L, Sorjonen K. Exploring associations between subjective well-being and personality over a time span of 15-18 months: a cohort study of adolescents in Sweden. BMC Psychol 2021; 9:173. [PMID: 34740376 PMCID: PMC8569843 DOI: 10.1186/s40359-021-00673-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/14/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Subjective well-being (SWB) is a contributing factor for building resilience and a resource for positive outcomes, e.g. study achievement and work performance. Earlier studies have examined associations between and prospective effects of personality traits on SWB, but few addressed the role that SWB plays in formation of personality over time. The purpose of our study was to examine associations and prospective effects of SWB on personality traits and vice versa in a cohort sample of secondary school students in Sweden who completed self-reported measures of SWB and personality traits at baseline (N = 446, 76% females) and at 15–18 month follow-up (N = 283, 71% females). Methods SWB was defined and measured by the WHO-5 Well-being Index and the Satisfaction with Life Scale. The Big Five Inventory was used to measure personality traits. Autoregressive models were used to analyse associations and potential prospective effects of SWB on personality traits and vice versa. Results Low levels of neuroticism and high levels of extraversion, conscientiousness and agreeableness were associated with high levels of SWB at baseline and follow-up. The association between SWB and neuroticism was notably strong. We found high statistically significant rank order stability across the two time points for all measures of personality traits with stability effects, derived from the autoregressive models, ranging from .199 for extraversion to .440 for neuroticism. Stability for SWB was statistically significant across the two time points and ranged from .182 for well-being to .353 for life satisfaction. SWB had a prospective effect on agreeableness only. None of the personality traits had any significant prospective effects on SWB. Conclusions The present findings indicate that although correlated, bidirectional prospective effects between personality traits and SWB could not be confirmed. Neuroticism displayed the strongest negative association with adolescents’ SWB. Schools are an appropriate setting to improve well-being, and allocating resources that reduce neuroticism is crucial, including structural interventions, policies for healthy school settings and teaching emotional regulation techniques. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00673-9.
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Affiliation(s)
- Regina Winzer
- Department of Global Public Health, Karolinska Institutet, 17165, Stockholm, Sweden. .,Department of Living Conditions and Lifestyles, Public Health Agency of Sweden, 17182, Solna, Sweden.
| | - Marjan Vaez
- Department of Living Conditions and Lifestyles, Public Health Agency of Sweden, 17182, Solna, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Lene Lindberg
- Department of Global Public Health, Karolinska Institutet, 17165, Stockholm, Sweden.,Center for Epidemiology and Community Medicine, 10431, Stockholm, Sweden
| | - Kimmo Sorjonen
- Department of Clinical Neuroscience, Karolinska Institutet, 17177, Stockholm, Sweden
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7
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García-Moya I, Corell M, Paniagua C, Vaez M, Löfstedt P. School stress and health complaints: Testing the Adolescent Stress Questionnaire in Spain and Sweden. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
According to the Health Behaviour in School-aged Children (HBSC) study, over a third of adolescents feel pressured by schoolwork in European countries, with increases associated to age and in girls. School pressure has been linked with increased health complaints, which illustrates the importance of schools from a public health perspective. To get a better understanding of school stress in adolescence, there is a need to test measures that reflect a broader array of potential school-related stressors. The aims of this cross-national study were: (1) to analyze the functioning of a specific measure to assess school stress in adolescence and (2) to examine the links between school stress and health complaints.
Methods
The sample consisted of students aged 13 and 15 years: 1,249 students (54.6% girls) who had participated in project EASE in Spain, and 576 students (50.6% girls) in Sweden. The measure tested was the Adolescent Stress Questionnaire (ASQ-S), specifically the 9 items on school stress from the subscales school performance, future uncertainty, and school-leisure conflict. For the assessment of health complaints, the HBSC health complaints checklist was used.
Results
CFA supported a three-correlated factor structure and a high reliability of the three subscales of the ASQ-S in both countries. In regression analyses, the association between school stress and health complaints was significant when controlling age and sex, with the increase in the level of explained variability due to several stress dimensions being 18.8% in Spain and 25.2% in Sweden.
Conclusions
Different facets of school life can contribute to stress during adolescence, with more public health attention needed when it comes to school stress and its links with increased health complaints.
Key messages
The instrument used for school stress may be useful in cross-national studies in adolescent samples. More public health attention should be paid to school stress and its links with increased health complaints in adolescence.
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Affiliation(s)
- I García-Moya
- Department of Developmental and Educational Psychology, Universidad de Sevilla, Sevilla, Spain
| | - M Corell
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Göteborg, Sweden
- Public Health Agency of Sweden, Solna, Sweden
| | - C Paniagua
- Department of Developmental and Educational Psychology, Universidad de Sevilla, Sevilla, Spain
| | - M Vaez
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Insurance Medicine, Stockholm, Sweden
- Public Health Agency of Sweden, Solna, Sweden
| | - P Löfstedt
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Göteborg, Sweden
- Public Health Agency of Sweden, Solna, Sweden
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Solberg Ø, Vaez M, Johnson-Singh CM, Saboonchi F. Corrigendum to 'Asylum-seekers' psychosocial situation: A diathesis for post-migratory stress and mental health disorders?' [Journal of Psychosomatic Research 130 (2020) 109914]. J Psychosom Res 2020; 138:110254. [PMID: 33002809 DOI: 10.1016/j.jpsychores.2020.110254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Øivind Solberg
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway; Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden.
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden
| | - Charisse M Johnson-Singh
- Epidemiology and Public Health Intervention Research Group (EPHIR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden
| | - Fredrik Saboonchi
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden
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Solberg Ø, Nissen A, Vaez M, Cauley P, Eriksson AK, Saboonchi F. Children at risk: A nation-wide, cross-sectional study examining post-traumatic stress symptoms in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden between 2014 and 2018. Confl Health 2020; 14:67. [PMID: 33024451 PMCID: PMC7531165 DOI: 10.1186/s13031-020-00311-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/18/2020] [Indexed: 12/19/2022] Open
Abstract
Background The objective of the present study was to assess nation-wide, representative prevalence estimates for symptom-defined posttraumatic stress disorder (PTSD) within populations of refugee minors from Afghanistan, Syria and Iraq resettled in Sweden. Methods A nation-wide, cross-sectional, questionnaire study with a stratified sample of refugee minors, aged 16–18 years, from Afghanistan, Iraq and Syria, resettled in Sweden between 2014 and 2018 (N = 5071) was conducted. The response rate was 22.3%, leaving n = 1129 refugee minors (boys 53.1% / girls 46.9%) in the final sample. Symptom-defined prevalences of PTSD were measured using CRIES-8 with ≥17 as cut-off. Data were analyzed using frequency distributions, and strata-specific PTSD prevalences with 95% confidence intervals (95% CIs), were estimated. The association between migratory status on arrival (unaccompanied vs. accompanied) and PTSD was estimated using crude and adjusted odds ratios (OR) utilizing logistic regression analyses with 95% CIs. Results Overall, the weighted PTSD prevalence was 42% (95% CI 38.9–45.1), with minors from Afghanistan presenting the highest prevalence (56.9, 95% CI 51.5–62.2), compared to minors from Iraq (36.8, 95% CI 28.9–45.4) and Syria (33.4, 95% CI 29.4–37.6). Unaccompanied minors from Afghanistan had higher odds of PTSD compared to accompanied minors from Afghanistan (OR = 1.92, 95% CI 1.08–3.40). Gender differences were non-significant. Conclusions High prevalences of symptom-defined PTSD among refugee minors in general and in unaccompanied minors from Afghanistan in particular, were revealed. Findings calls for continued efforts to support this especially vulnerable group.
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Affiliation(s)
- Øivind Solberg
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, P.box 181, 0409 Oslo, Nydalen Norway.,Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden
| | - Alexander Nissen
- Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden.,Division for Forced migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Marjan Vaez
- Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Unit of Mental Health, Children and Youth, The Public Health Agency of Sweden, Solna, Sweden
| | - Prue Cauley
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, P.box 181, 0409 Oslo, Nydalen Norway
| | - Anna-Karin Eriksson
- Unit of Mental Health, Children and Youth, The Public Health Agency of Sweden, Solna, Sweden
| | - Fredrik Saboonchi
- Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Lövestad S, Vaez M, Löve J, Hensing G, Krantz G. Intimate partner violence, associations with perceived need for help and health care utilization: a population-based sample of women in Sweden. Scand J Public Health 2020; 49:268-276. [PMID: 32854572 PMCID: PMC8056709 DOI: 10.1177/1403494820930952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: To assess the association between physical intimate partner violence (physical IPV) in the past 5 years, perceived need for help and primary health care utilization due to mental health problems in a general population-based sample of women in Sweden. Methods: We performed structured follow-up interviews with 616 women between 1995 and 2015. Associations between physical IPV in the past 5 years and (i) perceived need for help and (ii) primary health care utilization due to mental health problems, were estimated by logistic regression analyses with crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: Of the women who had experienced physical IPV in the past 5 years, 45.1% perceived a need for help but refrained from seeking care. After adjusting for sociodemographic factors, exposure to physical IPV in the past 5 years remained associated with perceived need for help (OR 3.54; CI 1.77–7.11). After adjusting for sociodemographic factors, the association between exposure to physical IPV and primary health care utilization did not remain statistically significant. Conclusions: Women exposed to physical IPV were more likely to perceive the need for help compared with unexposed women. A large proportion of IPV-exposed women in the general population may refrain from seeking care although they perceive a need for help. Future studies need to investigate potential barriers to mental health care seeking among women exposed to IPV. Routine questioning about IPV should be implemented in primary health care with improved referral to available support services.
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Affiliation(s)
- Solveig Lövestad
- School of Public Health and Community Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Marjan Vaez
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Löve
- School of Public Health and Community Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Gunilla Krantz
- School of Public Health and Community Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
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Axén I, Björk Brämberg E, Vaez M, Lundin A, Bergström G. Interventions for common mental disorders in the occupational health service: a systematic review with a narrative synthesis. Int Arch Occup Environ Health 2020; 93:823-838. [PMID: 32246230 PMCID: PMC7452923 DOI: 10.1007/s00420-020-01535-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/12/2020] [Indexed: 12/14/2022]
Abstract
Introduction Common mental disorders (CMD) are leading causes of decreased workability in Sweden and worldwide. Effective interventions to prevent or treat such disorders are important for public health. Objective To synthesize the research literature regarding occupational health service (OHS) interventions targeting prevention or reduction of CMD among employees. The effect on workability (sickness absence, return-to-work and self-reported workability) and on CMD symptoms was evaluated in a narrative analysis. Data sources The literature search was performed in four electronic databases in two searches, in 2014 and in 2017. Eligibility criteria (using PICO) Population: studies investigating employees at risk or diagnosed with CMD, as well as preventive workplace intervention targeting mental health. Intervention: studies where the recruitment or the intervention was delivered by the OHS or OHS personnel were included. Control: individuals or groups who did not receive the target intervention. Outcome: all types of outcomes concerning sickness absence and psychological health were included. Study quality was assessed using a Swedish AMSTAR-based checklist, and results from studies with low or medium risk of bias were narratively synthesized based on effect or absence thereof. Results Thirty-three studies were included and assessed for risk of bias. Twenty-one studies had low or medium risk of bias. In 18 studies, rehabilitation interventions were evaluated, 11 studies concerned interventions targeting employees at risk for developing CMD and four studies investigated preventive interventions. Work-focused cognitive behavioral therapy and problem-solving skill interventions decreased time to first return-to-work among employees on sick leave for CMD in comparison with treatment-as-usual. However, effect on return to full-time work was not consistent, and these interventions did not consistently improve CMD symptoms. Selective interventions targeting employees at risk of CMD and preventive interventions for employees were heterogeneous, so replication of these studies is necessary to evaluate effect. Limitations Other workplace interventions outside the OHS may have been missed by our search. There was considerable heterogeneity in the included studies, and most studies were investigating measures targeting the individual worker. Interventions at the workplace/organizational level were less common. Conclusions and implication of key findings Return-to-work and improvement of CMD symptoms are poorly correlated and should be addressed simultaneously in future interventions. Further, interventions for CMD administered through the occupational health service require further study. Rehabilitative and preventive strategies should be evaluated with scientifically robust methods, to examine the effectiveness of such interventions.
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Affiliation(s)
- Iben Axén
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Elisabeth Björk Brämberg
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30, Gothenburg, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Andreas Lundin
- Department for Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Gunnar Bergström
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Occupational Health Sciences and Psychology, University of Gävle Centre for Musculoskeletal Research, Kungsbäcksvägen 47, 801 76, Gävle, Sweden
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12
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Solberg Ø, Vaez M, Johnson-Singh CM, Saboonchi F. Asylum-seekers' psychosocial situation: A diathesis for post-migratory stress and mental health disorders? J Psychosom Res 2020; 130:109914. [PMID: 31935528 DOI: 10.1016/j.jpsychores.2019.109914] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/01/2019] [Accepted: 12/26/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE While flight experiences of refugees and asylum-seekers might differ profoundly, previous research has, to a large degree, not differentiated between these forcibly displaced groups. Furthermore, research has mainly focused on post-migratory stress measured after resettlement. The aim of this study was therefore to chart mental health disorders and the associations between mental health and early post-migratory stress among asylum-seekers. METHOD Using a cross sectional survey design, data collection was conducted from 2016 to 2018, in three large asylum-seekers' housing facilities located in Sweden. RESULTS In total 455 asylum-seekers from Afghanistan, Eritrea, Iraq, Somalia and Syria responded to the questionnaire. The most prevalent type of mental health disorder was depression (67.9%) followed by posttraumatic stress disorder (PTSD) (60.7%), and anxiety (59.3%). More men than women reported mental health disorders particularly with regard to anxiety and PTSD, and respondents with the lowest level of education (≤9 years) reported the highest levels of mental health problems. Associations between mental health disorders and post-migratory stress revealed that three post-migratory stressors were consistently the strongest indicators of mental health disorders. CONCLUSIONS Compared to previous research within populations of refugees who have received formal refugee status or resident permits, the prevalences of mental health disorders reported in the present study were substantially larger and the associations between post-migratory stressors and mental health disorders appears to be substantially stronger for asylum-seekers. This might suggest that the asylum-seekers' psychosocial situation becomes a diathesis or predisposition that interacts with early post-migratory stressors, in turn having detrimental effects on mental health.
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Affiliation(s)
- Øivind Solberg
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway; Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden.
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden
| | - Charisse M Johnson-Singh
- Epidemiology and Public Health Intervention Research Group (EPHIR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden
| | - Fredrik Saboonchi
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden
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13
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Wang M, Vaez M, Dorner TE, Rahman SG, Helgesson M, Ivert T, Mittendorfer-Rutz E. Sociodemographic, labour market marginalisation and medical characteristics as risk factors for reinfarction and mortality within 1 year after a first acute myocardial infarction: a register-based cohort study of a working age population in Sweden. BMJ Open 2019; 9:e033616. [PMID: 31857317 PMCID: PMC6937026 DOI: 10.1136/bmjopen-2019-033616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Research covering a wide range of risk factors related to the prognosis during the first year after an acute myocardial infarction (AMI) is insufficient. This study aimed to investigate whether sociodemographic, labour market marginalisation and medical characteristics before/at AMI were associated with subsequent reinfarction and all-cause mortality. DESIGN Population-based cohort study. PARTICIPANTS The cohort included 15 069 individuals aged 25-64 years who had a first AMI during 2008-2010. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome measures consisted of reinfarction and all-cause mortality within 1 year following an AMI, which were estimated by univariate and multivariable HRs and 95% CIs by Cox regression. RESULTS Sociodemographic characteristics such as lower education showed a 1.1-fold and 1.3-fold higher risk for reinfarction and mortality, respectively. Older age was associated with a higher risk of mortality while being born in non-European countries showed a lower risk of mortality. Labour market marginalisation such as previous long-term work disability was associated with a twofold higher risk of mortality. Regarding medical characteristics, ST-elevation myocardial infarction was predictive for reinfarction (HR: 1.14, 95% CI: 1.07 to 1.21) and all-cause mortality (HR: 3.80, 95% CI: 3.08 to 4.68). Moreover, diabetes mellitus, renal insufficiency, stroke, cancer and mental disorders were associated with a higher risk of mortality (range of HRs: 1.24-2.59). CONCLUSIONS Sociodemographic and medical risk factors were identified as risk factors for mortality and reinfarction after AMI, including older age, immigration status, somatic and mental comorbidities. Previous long-term work disability and infarction type provide useful information for predicting adverse outcomes after AMI during the first year, particularly for mortality.
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Affiliation(s)
- Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Thomas Ernst Dorner
- Department of Social and Preventive Medicine, Centre for Public Health, Medizinische Universitat Wien, Wien, Austria
| | - Syed Ghulam Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Torbjörn Ivert
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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14
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Bokenberger K, Rahman S, Wang M, Vaez M, Dorner TE, Helgesson M, Ivert T, Mittendorfer-Rutz E. Work disability patterns before and after incident acute myocardial infarction and subsequent risk of common mental disorders: A Swedish cohort study. Sci Rep 2019; 9:16086. [PMID: 31695106 PMCID: PMC6834568 DOI: 10.1038/s41598-019-52487-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/17/2019] [Indexed: 11/09/2022] Open
Abstract
This study investigated the extent to which work disability patterns including sickness absence and disability pension (SA/DP) before and after acute myocardial infarction (AMI) were associated with subsequent common mental disorders (CMDs) such as depression and anxiety in AMI patients without previous CMD. Total 11,493 patients 26–64 years with incident AMI during 2008–10 were followed up for CMD (measured as antidepressant prescription) through 2013. Four SA/DP trajectory groups during the 3-years pre-AMI and 1-year post-AMI were identified. Hazard ratios (HRs) with 95% confidence intervals for subsequent CMD were estimated in Cox models. Higher pre-AMI SA/DP annual levels (>1–12 months/year) were associated with 40–60% increased CMD rate than the majority (78%) with low increasing levels (increasing up to 1 month/year). Regarding post-AMI findings, constant high (~25–30 days/month) SA/DP levels within the first 3 months was associated with a 76% higher CMD rate, compared to constant low (0 days/month). A gradually decreasing post-AMI SA/DP pattern over a 12-month period suggested protective influences for CMD (HR = 0.80). This is the first study to demonstrate that pre- and post-AMI work disability patterns are associated with subsequent CMD risk in AMI patients. Work disability patterns should be considered as an indicator of AMI prognosis in terms of CMD risk.
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Affiliation(s)
- K Bokenberger
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - S Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - M Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - T E Dorner
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - M Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - T Ivert
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - E Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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15
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Bokenberger K, Rahman S, Wang M, Vaez M, Dorner TE, Helgesson M, Ivert T, Mittendorfer-Rutz E. Work disability before and after incident myocardial infarction and subsequent common mental disorder. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This study investigated the extent to which work-disability patterns including sickness absence and disability pension (SA/DP) before and after acute myocardial infarction (AMI) were associated with subsequent common mental disorders (CMDs) such as depression and anxiety in AMI patients without previous CMD.
Methods
A cohort of 11,493 patients aged 26-64 years without previous CMD with incident AMI during 2008-2010 were followed up for CMD measured as antidepressant prescription through 2013. Four SA/DP trajectory groups during the 3 years pre-AMI and 1 year post-AMI were identified. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated in Cox models.
Results
Higher pre-AMI SA/DP levels (>1-12 months/year), compared to the majority of patients (78%) following low increasing annual levels (increasing up to 1 month/year) of pre-AMI SA/DP, were associated with a 40-60% increased CMD rate. Regarding post-AMI findings, constant high (∼25-30 days/month) and steeply decreasing SA/DP levels within the first 3 months were associated with a 76% and 35% higher CMD rate, respectively, compared to constant low (<1 days/month) levels. Conversely, a gradually decreasing pattern of post-AMI SA/DP over a 12-month period suggested protective influences for CMD (HR = 0.80), even after adjusting for sociodemographic and medical factors.
Conclusions
This is the first study to demonstrate that pre- and post-AMI work disability patterns are associated with subsequent CMD risk in AMI patients. Work disability patterns should be considered in clinical practice as an indicator of AMI prognosis in terms of CMD risk.
Key messages
Increasing and high persistent levels of pre-AMI work disability are associated with higher risk of subsequent CMD, while gradually decreasing post-AMI work disability has a favourable CMD prognosis. Pre- and post-AMI patterns of work disability (sickness absence and disability pension) can be a useful marker in terms of CMD prognosis.
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Affiliation(s)
- K Bokenberger
- Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - S Rahman
- Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M Wang
- Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M Vaez
- Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - T E Dorner
- Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Medizinische Universitat Wien, Institute of Social Medicine, Centre for Public Health, Viena, Austria
| | - M Helgesson
- Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - T Ivert
- Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - E Mittendorfer-Rutz
- Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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16
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Sengoelge M, Johnson-Singh CM, Mittendorfer-Rutz E, Vaez M, Saboonchi F. Identifying subgroups of refugees from Syria resettled in Sweden based on multiple trauma exposures: A latent class analysis of trauma history and mental health outcomes. J Psychosom Res 2019; 125:109814. [PMID: 31470254 DOI: 10.1016/j.jpsychores.2019.109814] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many refugees have been subjected to pre-migratory trauma. Evidence is needed to address the heterogeneity within refugee populations in regard to patterns of multiple trauma exposures. This study identified subgroups within a refugee population displaying different profiles of multiple trauma exposures and assessed sociodemographic predictors and differences in mental health symptom severity across these classes. METHODS Study population consisted of 1215 refugees from Syria resettled in Sweden. Latent class analysis 3-step method for modelling predictors and outcomes and a class-specific weighted multigroup approach were used to identify classes of refugees using self-reported data on violent and non-violent trauma exposures, sociodemographic variables and symptom severity scores for depression, anxiety and PTSD. RESULTS Three classes were identified: class 1 'multiple violent and non-violent trauma' (39.3%, n = 546); class 2 'witnessing violence and multiple non-violent trauma' (40.8%, n = 569); and class 3 'low multiple non-violent trauma' (20.1%, n = 281). Trauma exposure and gender significantly predicted class membership. Male gender and highest severity of mental ill health defined class 1. Female gender predicted higher mental ill health within classes 1 and 2. Across all three classes living with a partner was associated with lower severity of mental ill health regardless of trauma exposure classes. CONCLUSIONS There are distinct patterns within refugee populations concerning exposure to multiple trauma. Violence is a primary marker for higher likelihood of multiple trauma exposures and severity of mental health. Gender predisposes individuals to trauma exposure and its outcomes differentially.
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Affiliation(s)
- Mathilde Sengoelge
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden.
| | - Charisse M Johnson-Singh
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Saboonchi
- Department of Health Sciences, Swedish Red Cross University College, Stockholm, Sweden; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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17
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Gottvall M, Vaez M, Saboonchi F. Social support attenuates the link between torture exposure and post-traumatic stress disorder among male and female Syrian refugees in Sweden. BMC Int Health Hum Rights 2019; 19:28. [PMID: 31488136 PMCID: PMC6727543 DOI: 10.1186/s12914-019-0214-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 08/29/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aim of this study is threefold: (i) to establish the psychometric properties and gender invariance of ENRICHD Social Support Inventory (ESSI), which was used for the first time in the present study in the population of Syrian refugees resettled in Sweden; (ii) to assess whether gender moderates the associations between social support, exposure to torture and PTSD; (iii) to assess whether social support mediates the association between exposure to torture and PTSD, and whether this mediation is in turn moderated by gender. METHODS Data from a cross-sectional and population-based study of a random sample of Syrian refugees (n = 1215) resettled in Sweden 2011-2013 was analyzed within a Structural Equation Modeling (SEM) framework. RESULTS Our results indicate adequate fit and gender invariance for a unidimensional model of ESSI. Exposure to torture was associated with lower social support (B = -0.22, p < 0.01) and with higher odds ratio (OR) for PTSD (OR 2.52, 95% Confidence interval (CI) 1.83-3.40). Furthermore, higher social support was associated with less likelihood for PTSD (B = -0.56, p < 0.001). Social support partially mediated the effect of torture exposure on PTSD (OR 1.13, 95% bias corrected bootstrap CI 1.06-1.26). Gender did not moderate this pattern. CONCLUSION The results indicate that social support attenuates the link between torture exposure and PTSD, and may function as a protective factor for PTSD among both torture-exposed refugee men and women.
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Affiliation(s)
- Maria Gottvall
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Clinical Psychology in Health Care, Department of Women’s and Children’s Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden
| | - Marjan Vaez
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Fredrik Saboonchi
- Department of Health Sciences, The Swedish Red Cross University College, PO Box 1059, SE-141 21 Huddinge, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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18
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Gonäs L, Wikman A, Vaez M, Alexanderson K, Gustafsson K. Changes in the gender segregation of occupations in Sweden between 2003 and 2011. Scand J Public Health 2019; 47:344-347. [DOI: 10.1177/1403494819831910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: The aim of this study was to analyze possible changes in the gender composition of occupations in Sweden, using register data covering the whole working population. Methods: Cross tabulations on gender by occupation were computed and comparisons made of numbers and proportions of women and men aged 20–64 years to illustrate occupational gender-segregation categories in 2003 and 2011, respectively. All of those in working ages, employed in 2003 and 2011 (4.2 resp 4.7 millions individuals), were included. Differences in the distribution of women and men in all occupations were summarized using two gender-segregation indexes from 2003 and 2011, separately. Results: The proportion of women increased in the gender-integrated (⩾40–<60% women) occupations. Also, the proportion of women in high-skilled professional occupations in the male-dominated category increased, as well as the proportion of men in mostly low-skilled female-dominated occupations, mainly in the service sector. The gender-segregation of occupations measured by the Index of Dissimilarly and the Karmel and MacLachlan Index was lower in 2011 than in 2003. Conclusions: The process of de-segregation has continued during our study period, from 2003 to 2011. The proportion of women increased in occupations that demand higher education, both in gender-integrated and in male-dominated occupations, which can contribute to a decrease in the level of sickness absence for women. Men increased their proportion in low-skilled, female-dominated occupations – a group with high levels of sickness absence or disability pension.
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Affiliation(s)
- Lena Gonäs
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Wikman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Klas Gustafsson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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19
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Lövestad S, Löve J, Vaez M, Waern M, Hensing G, Krantz G. Suicidal ideation and attempts in population-based samples of women: temporal changes between 1989 and 2015. BMC Public Health 2019; 19:351. [PMID: 30922272 PMCID: PMC6440083 DOI: 10.1186/s12889-019-6685-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/20/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Little is known about temporal changes in the prevalence of self-reported suicidal ideation and attempts within general populations of women. The aim of this study was to assess the prevalence of self-reported suicidal ideation and attempts over a 26 year period (1989-2015) among women from the general population aged 20-49 years. A further aim was to investigate associations between sociodemographic factors and lifetime suicidal ideation over this study period. METHODS A total of 2072 structured personal interviews were performed with a stratified population-based sample of women between 1989 and 2015. Questions about lifetime suicidal ideation and attempts as well as sociodemographic factors were assessed at four data collection waves. Lifetime prevalence of suicidal ideation and attempts were compared through analysis of differences between two independent proportions and their 95% Confidence Intervals (CI). Associations between sociodemographic factors and lifetime suicidal ideation were estimated by weighted odds ratios (OR). RESULTS Women aged 20-30 years reported higher lifetime prevalence of suicidal ideation in 2013-2015 compared to 1989-1991 (45 and 33% respectively). Rates of lifetime suicide attempts remained similar between these time points (3.5 and 3.1% respectively). Women aged 31-49 years reported higher lifetime prevalence of suicidal ideation in 2013-2015 compared to 2000-2002 (35.4 and 23.1% respectively). In this age group, lifetime suicide attempts increased from 0.0% in 2000-2002 to 3.6% in 2013-2015. Women aged 20-30 years who were single, unemployed or had low educational attainment had higher OR of lifetime suicidal ideation compared to the reference categories in most of the study waves. In 2013-2015, young students had lower OR of lifetime suicidal ideation (OR 0.34; 95% CI 0.17-0.69) compared to those with employment. Women aged 31-49 years, who were single, had higher OR of lifetime suicidal ideation (OR 2.61; 95% CI 1.06-6.44) than married, cohabiting women and this was observed in 2013-2015. CONCLUSION The results raise a general concern about an increasing trend in suicidal ideation among young and middle-aged women. The current study expands on previous research by demonstrating that sociodemographic factors may show changing patterns in the associations with lifetime suicidal ideation over time.
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Affiliation(s)
- Solveig Lövestad
- Department of Community Medicine and Public Health, Sahlgrenska Academy at the University of Gothenburg, Box 453, 405 30, Göteborg, Sweden.
| | - Jesper Löve
- Department of Community Medicine and Public Health, Sahlgrenska Academy at the University of Gothenburg, Box 453, 405 30, Göteborg, Sweden
| | - Marjan Vaez
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Berzelius väg 3, 171 77, Stockholm, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at University of Gothenburg, SU Sahlgrenska, 41345, Göteborg, Sweden
| | - Gunnel Hensing
- Department of Community Medicine and Public Health, Sahlgrenska Academy at the University of Gothenburg, Box 453, 405 30, Göteborg, Sweden
| | - Gunilla Krantz
- Department of Community Medicine and Public Health, Sahlgrenska Academy at the University of Gothenburg, Box 453, 405 30, Göteborg, Sweden
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20
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Wang M, Vaez M, Dorner TE, Rahman S, Helgesson M, Ivert T, Mittendorfer-Rutz E. Risk factors for subsequent work disability in patients with acute myocardial infarction. Eur J Public Health 2019; 29:531-540. [DOI: 10.1093/eurpub/cky279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Ernst Dorner
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Syed Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ivert
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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21
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Vaez M, Leijon O, Wikman A, Nord T, Lidwall U, Wiberg M, Alexanderson K, Gonäs L. A follow-up of the introduction of a maximum entitlement period for receiving sickness benefits in Sweden: A nationwide register-based study. Scand J Public Health 2019; 48:144-154. [PMID: 30632905 DOI: 10.1177/1403494818818258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2008, Sweden introduced a policy change to limit the number of days for sickness benefits (SB). This study aimed to elucidate the characteristics of those who reached the maximum entitlement period for receiving sickness benefits (MEPSB) and their future main source of income. Methods: All 5,309,759 individuals, aged 20-63 and residents of Sweden in 2009 were followed from July 2008 to July 2010 regarding SB-days and date of MEPSB and then categorised into three groups: I) no SB-days, II) ongoing SB-days, and III) MEPSB. Mean numbers of SB-days 2.5 years before and 2 years after the policy change and main source of income in 2011 were assessed. Associations between sociodemographic factors, occupation and paid work as main source of income were estimated by odds ratio (OR). Results: A total of 0.7% reached MEPSB in 2010. The mean numbers of SB-days before and after the policy change were higher in the MEPSB group than in the other two groups. In the MEPSB group, 14% had their main source of income from paid work in 2011; this was more common among women born in Sweden (OR = 1.29), people living with a partner and children (women OR = 1.29; men OR = 1.48), and those with occupations representing high educational levels. Conclusions: One out of seven individuals with MEPSB in 2010 had their main source of income from paid work in 2011, although they had a long-term SB before and after the policy change. Further research is warranted to address the long-term effects of this policy change.
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Affiliation(s)
- Marjan Vaez
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ola Leijon
- The Swedish Social Insurance Inspectorate, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Wikman
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tora Nord
- Department of Working Life Science, Karlstad University, Karlstad, Sweden
| | - Ulrik Lidwall
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Michael Wiberg
- Department of Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden
| | | | - Lena Gonäs
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Working Life Science, Karlstad University, Karlstad, Sweden
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Gonäs L, Wikman A, Vaez M, Alexanderson K, Gustafsson K. Gender segregation of occupations and sustainable employment: A prospective population-based cohort study. Scand J Public Health 2018; 47:348-356. [PMID: 29974817 DOI: 10.1177/1403494818785255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the labour market is characterized by a strong numerical gender segregation of occupations, there is little knowledge about the associations of this with the future labour market situation for an individual person. OBJECTIVES This study aimed to elucidate whether working in a gender-segregated or gender-integrated occupation is associated with future labour market attachment and sickness absence or disability pensions among women and men. METHODS We used a population-based prospective cohort study with univariate and multiple logistic regression analyses stratified by gender, including all people living in Sweden aged 20-56 years and in paid work in 2003 ( n=3,239,989). They were followed up eight years later with regard to employment status, sickness absence and disability pension. RESULTS Women and men employed in extremely female-dominated occupations in 2003 had the highest employment levels and the lowest unemployment levels at follow up in 2011. When adjusting for age, level of education and sector of employment, the highest odds ratios (ORs) for not being employed in 2011 were found for women working in extremely male-dominated occupations in 2003 (OR 1.27; 95% CI 1.21-1.33) and for men in female-dominated occupations (OR 1.42; 95% CI 1.39-1.45) relative to those in gender-integrated occupations. Women in extremely male-dominated occupations had the highest ORs for sickness absence or the receipt of a disability pension at follow up (OR 1.26; 95% CI 1.17-1.36) and men in female-dominated occupations had the highest OR 1.15 (95% CI 1.11-1.20). CONCLUSIONS For both women and men, the gender composition of the occupation they work in seems to be of importance for their future labour market attachment and sickness absence or receipt of a disability pension.
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Affiliation(s)
- Lena Gonäs
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Anders Wikman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Klas Gustafsson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
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Ivert T, Vaez M, Dorner TE, Rutz EM. Ichemic heart disease and common mental disorders and the risk of disability pension. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Ivert
- Karolinska Institutet, Stockholm, Sweden
| | - M Vaez
- Karolinska Institutet, Stockholm, Sweden
| | - TE Dorner
- Medical University Vienna, Vienna, Austria
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Petersson LM, Vaez M, Nilsson MI, Saboonchi F, Alexanderson K, Olsson M, Wennman-Larsen A. Sickness absence following breast cancer surgery: a two-year follow-up cohort study. Scand J Caring Sci 2017; 32:715-724. [DOI: 10.1111/scs.12502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/05/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Lena-Marie Petersson
- Division of Insurance Medicine; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Division of Nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Marjan Vaez
- Division of Insurance Medicine; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Marie I. Nilsson
- Division of Insurance Medicine; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Division of Nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
- Division of Social Work; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
- Department of Social Work; Karolinska University Hospital; Stockholm Sweden
| | - Fredrik Saboonchi
- Division of Insurance Medicine; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Red Cross University College; Stockholm Sweden
- Stress Research Institute; University of Stockholm; Stockholm Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Mariann Olsson
- Division of Social Work; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Agneta Wennman-Larsen
- Division of Insurance Medicine; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
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Wang M, Vaez M, Dorner TE, Tiihonen J, Voss M, Ivert T, Mittendorfer-Rutz E. Trajectories and characteristics of work disability before and after acute myocardial infarction. Heart 2017; 104:340-348. [PMID: 28864716 DOI: 10.1136/heartjnl-2017-311950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Scientific knowledge on work disability in terms of sickness absence and disability pension (SA/DP) among patients with acute myocardial infarction (AMI) is scarce. The study aimed to investigate trajectories of SA/DP among individuals with or without AMI and examined the associations between sociodemographic, morbidity and coronary revascularisation characteristics with such trajectories among patients with AMI. METHODS This is a population-based cohort study of 10 255 individuals aged 30-60 years who had a first AMI during 2008-2010 and were alive 30 days after AMI. Each case was matched by sociodemographics to one control without AMI. Trajectories of annual SA/DP months over a 6-year period for cases and controls were analysed by group-based trajectory modelling. Associations of characteristics with trajectory groups were estimated by Χ2 test and multinomial logistic regression. RESULTS The majority of patients (59%) had slightly increased annual levels of SA/DP (1 month) at the time of AMI, which returned to no SA/DP 2 years after the event. One group (4%) had increasing SA/DP months preceding and after AMI. Three groups showed constant SA/DP months on low (14%), medium (9%) and high (15%) levels. Sex, unemployment, education, musculoskeletal disorders and prescription of antidepressants were the strongest factors discriminating the SA/DP trajectories (R2difference=0.02-0.03, p<0.01). CONCLUSIONS The majority of patients with AMI have a good outcome in terms of low levels of work disability within 2 years after AMI. Patterns of SA/DP before AMI, sex, socioeconomic status as well as comorbid musculoskeletal and mental disorders provide crucial clinical information on work disability after AMI.
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Affiliation(s)
- Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Ernst Dorner
- Department for Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Margaretha Voss
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department for Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Torbjörn Ivert
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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26
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Vaez M, Dalén M, Friberg Ö, Nilsson J, Frøbert O, Lagerqvist B, Ivert T. Regional differences in coronary revascularization procedures and outcomes: a nationwide 11-year observational study. European Heart Journal - Quality of Care and Clinical Outcomes 2017; 3:243-248. [DOI: 10.1093/ehjqcco/qcx007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/27/2017] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The study investigated whether regional differences in choice of coronary revascularization affected outcomes in Sweden.
Methods and results
We conducted a prospective nationwide study of outcome in patients undergoing coronary artery bypass grafting (CABG, n = 47 065) or percutaneous coronary intervention (PCI, n = 140 945) from 2001 through 2011, tracked for a median of 5 years. During this period, the proportion of CABG in revascularization procedures decreased nationwide from an average of 38% to 18%e. Three-vessel disease and left main stem coronary artery stenosis were more common among CABG patients than in PCI patients. In both males and females, all-cause mortality was higher in CABG patients than in PCI patients, while repeat PCI was performed more frequently in the PCI group. CABG proportions in 21 counties ranged from 13% to 42% in females and males. The combined outcomes of repeat revascularization, non-fatal acute myocardial infarction, and death during the tracking period was recorded in 151 936 patients without ST-elevation myocardial infarction after PCI (n = 37 820, 36%) and CABG (n = 18 903, 40%). The multivariable adjusted risk of combined outcomes was higher after both PCI and CABG in both females and males in the three quartiles of counties with a smaller proportion of CABG than in the quartile of counties with the highest proportion of CABG. Similar patterns persisted after including only mortality in the analyses.
Conclusion
There are subgroups of patients who have prognostic benefits of CABG in addition to symptomatic improvement that is well documented with both PCI and CABG.
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Affiliation(s)
- Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Dalén
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Sweden
| | - Johan Nilsson
- Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Ole Frøbert
- Faculty of Health, Department of Cardiology, Örebro University Hospital, Örebro University, Sweden
| | - Bo Lagerqvist
- Department of Medical Sciences, Cardiology Section, Uppsala Clinical, Research Center, Uppsala University, Uppsala, Sweden
| | - Torbjörn Ivert
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Lövestad S, Löve J, Vaez M, Krantz G. Prevalence of intimate partner violence and its association with symptoms of depression; a cross-sectional study based on a female population sample in Sweden. BMC Public Health 2017; 17:335. [PMID: 28424072 PMCID: PMC5397670 DOI: 10.1186/s12889-017-4222-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/01/2017] [Indexed: 12/04/2022] Open
Abstract
Background Intimate Partner Violence (IPV) is the most common type of violence targeting women. IPV includes acts of physical aggression, sexual coercion, psychological abuse and controlling behaviors and these forms of violence often coexist in the same relationship. Living with IPV is associated with serious mental health outcomes such as depression and depressive symptoms. Few population based studies from Sweden have investigated the relationship between different forms of IPV and women’s depressive symptoms and even fewer used controlling behavior as an independent variable in such studies. The aim of this study was therefore to assess the prevalence of exposure to IPV in terms of controlling behavior, sexual, and physical violence and their association with self-reported symptoms of depression in a female population based sample. Methods The cross-sectional, population based sample contained 573 women aged 18–65 years randomly selected in Sweden. Five self-reported symptoms that define depression in the Diagnostic and Statistical Manual of Mental Disorders were assessed. Physical and sexual violence were inquired about using the World Health Organization’s (WHO) Violence Against Women Instrument (VAWI), while controlling behavior was assessed with the Controlling Behavior Scale (CBS). Associations between different forms of IPV and symptoms of depression were estimated by crude and adjusted odds ratio (OR) with 95% confidence intervals (CI). Results Bivariable associations revealed that women exposed to controlling behavior, had higher OR of depressive symptoms compared to unexposed women (OR 2.43; 95% CI 1.63–3.63). Women exposed to physical and sexual violence had also a higher OR of depressive symptoms (OR 3.78; 95% CI 1.99–7.17 and OR 5.10; 95% CI 1.74–14.91 respectively). After adjusting for socio-demographic and psychosocial covariates, all three forms of IPV showed statistically significant associations with self-reported symptoms of depression. Conclusions A strength with this study is the analysis of controlling behavior and its association with self-reported symptoms of depression in a female population based sample. Exposure to controlling behavior, physical and sexual violence by an intimate partner were clearly associated with women’s self-reported symptoms of depression.
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Affiliation(s)
- Solveig Lövestad
- Department of Community Medicine and Public Health, Sahlgrenska Academy at University of Gothenburg, Box 453, 405 30, Göteborg, Sweden.
| | - Jesper Löve
- Department of Community Medicine and Public Health, Sahlgrenska Academy at University of Gothenburg, Box 453, 405 30, Göteborg, Sweden
| | - Marjan Vaez
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE- 171 77, Stockholm, Sweden
| | - Gunilla Krantz
- Department of Community Medicine and Public Health, Sahlgrenska Academy at University of Gothenburg, Box 453, 405 30, Göteborg, Sweden
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Mittendorfer-Rutz E, Ivert T, Vaez M, Dorner TE. Synergistic effect between ischaemic heart disease and common mental disorders and the risk of premature exit from the labour market: a nationwide register based study from Sweden. Eur Heart J 2017; 39:578-585. [DOI: 10.1093/eurheartj/ehx183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/22/2017] [Indexed: 01/18/2023] Open
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Lundin A, Leijon O, Vaez M, Hallgren M, Torgén M. Predictive validity of the Work Ability Index and its individual items in the general population. Scand J Public Health 2017; 45:350-356. [DOI: 10.1177/1403494817702759] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: This study assesses the predictive ability of the full Work Ability Index (WAI) as well as its individual items in the general population. Methods: The Work, Health and Retirement Study (WHRS) is a stratified random national sample of 25–75-year-olds living in Sweden in 2000 that received a postal questionnaire ( n = 6637, response rate = 53%). Current and subsequent sickness absence was obtained from registers. The ability of the WAI to predict long-term sickness absence (LTSA; ⩾ 90 consecutive days) during a period of four years was analysed by logistic regression, from which the Area Under the Receiver Operating Characteristic curve (AUC) was computed. Results: There were 313 incident LTSA cases among 1786 employed individuals. The full WAI had acceptable ability to predict LTSA during the 4-year follow-up (AUC = 0.79; 95% CI 0.76 to 0.82). Individual items were less stable in their predictive ability. However, three of the individual items: current work ability compared with lifetime best, estimated work impairment due to diseases, and number of diagnosed current diseases, exceeded AUC > 0.70. Excluding the WAI item on number of days on sickness absence did not result in an inferior predictive ability of the WAI. Conclusions: The full WAI has acceptable predictive validity, and is superior to its individual items. For public health surveys, three items may be suitable proxies of the full WAI; current work ability compared with lifetime best, estimated work impairment due to diseases, and number of current diseases diagnosed by a physician.
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Affiliation(s)
- Andreas Lundin
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Ola Leijon
- Swedish Social Insurance Inspectorate, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Department of Clinical Neuroscience, Karolinska Institutet, Division of Insurance Medicine, Stockholm, Sweden
| | - Mats Hallgren
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Torgén
- Department of Medical Science, Uppsala University, Uppsala, Sweden
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Lageborn CT, Ljung R, Vaez M, Dahlin M. Ongoing university studies and the risk of suicide: a register-based nationwide cohort study of 5 million young and middle-aged individuals in Sweden, 1993-2011. BMJ Open 2017; 7:e014264. [PMID: 28363927 PMCID: PMC5387952 DOI: 10.1136/bmjopen-2016-014264] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the risk of suicide, unnatural death and all-cause death in university students compared with non-students, taking previous educational attainment into account. DESIGN Open cohort study of all residents aged 18-39 and living in Sweden at any time between 1 January 1993 and 31 December 2011. SETTING We linked data from national registers and calculated person-years during university studies for three time periods (1993-1999, 2000-2005 and 2006-2011). Time as non-student was calculated and categorised according to attained educational level. Incidence rate ratios (IRR) with 95% CIs were calculated with Poisson regression models, controlling for age and period. PARTICIPANTS The cohort consisted of 5 039 419 individuals, 51% men and 49% women. MAIN OUTCOME MEASURES Incidence of suicide (International Classification of Diseases (ICD)-9: E950-E959, ICD-10: X60-X84) or death with undetermined intent (ICD-9: E980-E989, ICD-10: Y10-Y34), unnatural death (ICD-9: E800-E999 and ICD-10: V01-Y99) and all-cause death. RESULTS A total of 7316 deaths due to suicide were identified, of which 541 were registered among university students. The risk of suicide was twofold during ongoing university studies compared with when having attained university education, IRR 2.37 (95% CI 2.07 to 2.72) in men and IRR 2.15 (95% CI 1.77 to 2.61) in women. CONCLUSIONS Having ongoing university studies was associated with a higher risk of suicide compared with having attained university-level education. This finding highlights the importance of achieving a deeper understanding of suicidal behaviour during years at university. Further studies should assess risk factors for suicide and suicidal behaviour in university students.
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Affiliation(s)
- Christine Takami Lageborn
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marie Dahlin
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Leijon O, Balliu N, Lundin A, Vaez M, Kjellberg K, Hemmingsson T. Effects of psychosocial work factors and psychological distress on self-assessed work ability: A 7-year follow-up in a general working population. Am J Ind Med 2017; 60:121-130. [PMID: 27779327 DOI: 10.1002/ajim.22670] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Toinvestigate the effects of psychosocial work factors (PWF) and psychological distress (PD) on self-assessed work ability. METHODS This follow-up study included 7,810 individuals (55%women) with good work ability at baseline. PWFandPD (measured by GHQ-12) were assessed at baseline and work ability at 7-year follow-up. Effects of PWF and PD on work ability were analyzed by logistic regression, odds ratios (OR) with 95% CI, and by mediation analysisusing 4-way decomposition. RESULTS Low support was associated with poor work ability for both women and men (OR 1.78 and 1.89). For men, also low skill discretion was associated with poor work ability (OR 2.07). For both women and men, PD was associated with poor work ability (OR 3.41 and 1.84). PD did not act as an intermediate variablein the association between PWF and work ability. CONCLUSION Strategies for sustainable work ability should focus on both working conditions and health factors. Am. J. Ind. Med. 60:121-130, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ola Leijon
- Swedish Social Insurance Inspectorate; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Natalja Balliu
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - Andreas Lundin
- Department of Public Health Sciences; Karolinska Institutet; Stockholm Sweden
| | - Marjan Vaez
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Katarina Kjellberg
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - Tomas Hemmingsson
- Centre for Social Research on Alcohol and Drugs (SoRAD); Stockholm University; Stockholm Sweden
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Vaez M, Creutz S, Wadman C, Sävelind L, Hansson F, Risbeck M. Monitoring system for a cohesive strategy for alcohol, narcotic drugs, doping and tobacco policy. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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33
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Lövestad S, Löve J, Vaez M, Krantz G. Intimate partner violence and its association with depression: a population-based study in Sweden. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw166.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sigvardsdotter E, Malm A, Tinghög P, Vaez M, Saboonchi F. Refugee trauma measurement: a review of existing checklists. Public Health Rev 2016; 37:10. [PMID: 29450052 PMCID: PMC5809946 DOI: 10.1186/s40985-016-0024-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/01/2016] [Indexed: 11/23/2022] Open
Abstract
Abstract Studies have shown that a high proportion of refugees have been subjected to potentially traumatic experiences (PTEs). PTEs, including torture, are powerful predictors of mental ill health. This paper reports a review of refugee trauma history self-report measures used in population studies. Methods A review of existing instruments and checklists, up to September 2015, was performed. Results The types of measures for refugee trauma history vary from semi-structured interviews and medical records to extensive multi-item trauma-checklists. The Harvard Trauma Questionnaire (HTQ) was the most commonly used instrument for measuring trauma history among refugee populations. Few checklists included PTEs during the flight. Conclusion Trauma history checklists are often used as a tool to control for background variables when studying refugees’ mental health and have mostly been developed in clinical or semi-clinical settings. There is a need for acceptable, reliable and valid brief checklists for measuring trauma in refugees, for the purpose of performing larger scale population studies.
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Affiliation(s)
- Erika Sigvardsdotter
- 1The Swedish Red Cross University College, Box 1059, 141 21 Huddinge, Stockholm Sweden
| | - Andreas Malm
- 1The Swedish Red Cross University College, Box 1059, 141 21 Huddinge, Stockholm Sweden.,2Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Swedish Red Cross Treatment Center for Persons Affected by War and Torture, Malmö, Sweden
| | - Petter Tinghög
- 1The Swedish Red Cross University College, Box 1059, 141 21 Huddinge, Stockholm Sweden.,2Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- 2Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Saboonchi
- 1The Swedish Red Cross University College, Box 1059, 141 21 Huddinge, Stockholm Sweden.,2Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Burrows S, Vaez M, Laflamme L. Sex-specific suicide mortality in the South African urban context: The role of age, race, and geographical location. Scand J Public Health 2016; 35:133-9. [PMID: 17454916 DOI: 10.1080/14034940600975773] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aims: This study investigates the importance of sociodemographic and geographical characteristics for suicide risks in the South African urban context. Suicide epidemiology is under-researched in low- and middle-income countries, and such knowledge is important not only for local and national policy, but also for a global understanding of the phenomenon. Methods: Sex-specific crude and adjusted odds ratios (95% confidence intervals) for suicide by age, race, and city are assessed using logistic regression. Cases aged 45+ years, classified as ``Coloured'' (a category denoting mixed racial origin), and living in Cape Town are used as reference groups. Additionally, the proportion of leading suicide methods within groups was estimated (95% confidence intervals). Results: For males, compared with each reference group, the odds of suicide are significantly higher during middle adulthood, among Asians and particularly among Whites, and among residents of all but one city. Patterns for women differ in magnitude and distribution. Suicide odds are significantly higher in all age groups, particularly 15—24 years, among Whites, and among residents of all other cities, particularly Nelson Mandela or Buffalo City. Males living in Tshwane and Black females have lower odds of suicide. The distribution of methods across age, race, and city groups varies little for males but substantially for females. Conclusions: Age, race, and city play independent roles in sex-specific suicide rates. As for high-income settings, age, race, method and city are important in sex-specific suicide in the urban South African context. Possible underlying mechanisms deserve greater attention for context-relevant preventive efforts.
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Affiliation(s)
- Stephanie Burrows
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Saboonchi F, Petersson LM, Wennman-Larsen A, Alexanderson K, Vaez M. Trajectories of Anxiety Among Women with Breast Cancer: A Proxy for Adjustment from Acute to Transitional Survivorship. J Psychosoc Oncol 2016; 33:603-19. [PMID: 26315500 DOI: 10.1080/07347332.2015.1082165] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination. To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within 2 years following BC surgery, survey data from a 2-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and Analysis of Variance. A piece-wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified: High Stable, High Decrease, Mild Decrease, and Low Decrease. Of these, High Stable anxiety showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties. Our results support an emphasis on the transitional nature of the stage that follows the end of primary active treatment and imply a need for supportive follow up care for those who display lack of adjustment at this stage.
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Affiliation(s)
- Fredrik Saboonchi
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,b Department of Medicine and Public Health , Red Cross University College , Stockholm , Sweden
| | - Lena-Marie Petersson
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Agneta Wennman-Larsen
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,c Sophiahemmet University, Stockholm , Sweden
| | - Kristina Alexanderson
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Marjan Vaez
- a Division of Insurance Medicine, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.,d Centre for Occupational and Environmental Medicine , Stockholm County Council , Stockholm , Sweden
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Sigvardsdotter E, Vaez M, Rydholm Hedman AM, Saboonchi F. Prevalence of torture and other warrelated traumatic events in forced migrants: A systematic review. Torture 2016; 26:41-73. [PMID: 27858780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM To describe and appraise the research literature reporting prevalence of torture and/or war-related potentially traumatic experiences (PTEs) in adult forced migrants living in high-income countries. METHODS A search for peer-reviewed articles in English was conducted in PubMed, Web of Science, PILOTS, key journals, and reference lists. Studies based on clinical samples and samples where less than half of participants were forced migrants were excluded. Data was extracted and a methodological quality appraisal was performed. RESULTS A total of 3,470 titles and abstracts were retrieved and screened. Of these, 198 were retrieved in full-text. Forty-one articles fulfilled inclusion criteria and the total number of study participants was 12,020 (median 170). A majority focused on specific ethnic groups or nationalities, Southeast Asian, Middle Eastern and Balkan being the most frequent. Reported prevalence rates of torture ranged between one and 76 % (median 27 %). Almost all participants across all studies had experienced some kind of war-related PTE. CONCLUSIONS Reported prevalence rates of torture and war-related PTEs vary between groups of forced migrants. Trauma history was often studied as a background variable in relation to mental health. The heterogeneity of data, as well as the methodological challenges in reaching forced migrants and defining and measuring traumatic experiences, prevent generalisation concerning trauma history across groups.
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Zetterström K, Voss M, Alexanderson K, Ivert T, Pehrsson K, Hammar N, Vaez M. Disability Pension at the Time of Coronary Revascularisation Is Associated with Higher Five-Year Mortality; A Swedish Nationwide, Register-Based Prospective Cohort Study. PLoS One 2015; 10:e0135277. [PMID: 26261990 PMCID: PMC4532455 DOI: 10.1371/journal.pone.0135277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/21/2015] [Indexed: 01/11/2023] Open
Abstract
Background Although coronary revascularisation by coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are common procedures, little is known regarding disability pension (DP) at the time of coronary revascularisation and its association with mortality. The aim was to investigate the five-year mortality following a first coronary revascularisation among women and men on DP, compared with those not on DP at the time of intervention, accounting for socio-demographic and medical factors. Material and Methods A nationwide prospective population-based cohort study was conducted, using national registers including 70,040 patients (80% men), aged 30–64 years, with a first CABG (n = 24,987; 36%) or PCI (n = 45,053; 64%) during 1994–2006 in Sweden, who were alive 30 days after the intervention. The main outcome was all-cause and cause-specific mortality within five years or through 31 December 2006, following CABG and PCI, and the exposure was DP at the time of a first coronary revascularisation. Information on DP, patient characteristics, date and cause of death was obtained from nationwide registers. Hazard ratios (HR) with 95% confidence intervals (CI) for the outcome were estimated, using Cox proportional hazard regression analyses. All analyses were stratified by type of intervention and gender. Findings Four percent died following coronary revascularisation. Cardiovascular disease was the most common cause of death (54%), followed by neoplasms (25%). Regardless of type of intervention, gender and after multivariable adjustments, patients on DP had a higher HR for five-year mortality compared with those not on DP at time of revascularisation (CABG: women HR 2.14; 95% CI 1.59–2.89, men HR 2.09; 1.84–2.38, PCI: women HR 2.25; 1.78–2.83, men HR 1.95; 1.72–2.21). Young women on DP at the time of PCI had a substantially higher HR (HR 4.10; 95% CI: 2.25–7.48). Conclusion Patients on DP at the time of first coronary revascularisation had a higher five-year risk of mortality compared with those not on DP.
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Affiliation(s)
- Katharina Zetterström
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Margaretha Voss
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Analysis and Forecasts, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Kristina Alexanderson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ivert
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Pehrsson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- AstraZeneca R&D, Mölndal, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Tidemalm D, Beckman K, Dahlin M, Vaez M, Lichtenstein P, Långström N, Runeson B. Age-specific suicide mortality following non-fatal self-harm: national cohort study in Sweden. Psychol Med 2015; 45:1699-1707. [PMID: 25425148 DOI: 10.1017/s0033291714002827] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Possible age-related differences in risk of completed suicide following non-fatal self-harm remain unexplored. We examined associations between self-harm and completed suicide across age groups of self-harming patients, and whether these associations varied by violent index method, presence of mental disorder, and repeated self-harm. METHOD The design was a cohort study with linked national registers in Sweden. The study population comprised individuals aged ⩾10 years hospitalized during 1990-1999 due to non-fatal self-harm (n = 53 843; 58% females) who were followed for 9-19 years. We computed hazard ratios (HRs) across age groups (age at index self-harm episode), with time to completed suicide as outcome. RESULTS The 1-year HR for suicide among younger males (10-19 years) was 14.6 [95% confidence interval (CI) 4.1-51.9] for violent method and 8.4 (95% CI 1.8-40.0) for mental disorder. By contrast, none of the three potential risk factors increased the 1-year risks in the youngest females. Among patients aged ⩾20 years, the 1-year HR for violent method was 4.6 (95% CI 3.8-5.4) for males and 10.4 (95% CI 8.3-13.0) for females. HRs for repeated self-harm during years 2-9 of follow-up were higher in 10- to 19-year-olds (males: HR 4.0, 95% CI 2.0-7.8; females: HR 3.7, 95% CI 2.1-6.5). The ⩾20 years age groups had higher HRs than the youngest, particularly for females and especially within 1 year. CONCLUSIONS Violent method and mental disorder increase the 1-year suicide risk in young male self-harm patients. Further, violent method increases suicide risk within 1 year in all age and gender groups except the youngest females. Repeated self-harm may increase the long-term risk more in young patients. These aspects should be accounted for in clinical suicide risk assessment.
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Affiliation(s)
- D Tidemalm
- Department of Clinical Neuroscience,Centre for Psychiatry Research,Karolinska Institutet,Stockholm,Sweden
| | - K Beckman
- Department of Clinical Neuroscience,Centre for Psychiatry Research,Karolinska Institutet,Stockholm,Sweden
| | - M Dahlin
- Department of Clinical Neuroscience,Centre for Psychiatry Research,Karolinska Institutet,Stockholm,Sweden
| | - M Vaez
- Division of Insurance Medicine,Department of Clinical Neuroscience,Karolinska Institutet,Stockholm,Sweden
| | - P Lichtenstein
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - N Långström
- Department of Medical Epidemiology and Biostatistics,Karolinska Institutet,Stockholm,Sweden
| | - B Runeson
- Department of Clinical Neuroscience,Centre for Psychiatry Research,Karolinska Institutet,Stockholm,Sweden
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Wennman-Larsen A, Petersson LM, Saboonchi F, Alexanderson K, Vaez M. Consistency of breast and arm symptoms during the first two years after breast cancer surgery. Oncol Nurs Forum 2015; 42:145-55. [PMID: 25806881 DOI: 10.1188/15.onf.145-155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the severity and development of breast and arm symptoms separately during the two years following breast cancer surgery, and to examine whether previously defined predictors of arm symptoms are associated with breast symptoms. DESIGN Prospective cohort study with two-year follow-up. SETTING Three institutions in the Stockholm, Sweden, region. SAMPLE 645 women, aged 20-63 years, enrolled within 12 weeks of surgery for primary breast cancer. METHODS Baseline register and questionnaire data with five follow-ups were submitted to descriptive, inferential, and logistic regression analysis. MAIN RESEARCH VARIABLES Severity of breast and arm symptoms measured by the European Organisation for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire. FINDINGS Most participants had undergone breast-conserving
surgery and sentinel lymph node dissection, and were scheduled for postoperative radiation therapy. Overall mean levels of breast and arm symptoms were low, but with large individual variations. At all six time points, the mean levels of breast symptoms were significantly higher than those of arm symptoms. Overall, the mean level of both types of symptoms decreased during follow-up. A body mass index (BMI) of 25 or greater and breast symptoms at eight months were associated with having breast symptoms at two years. Arm symptoms at baseline and at eight months, and radiation therapy and a BMI of 25 or greater were associated with having arm symptoms at two years. CONCLUSIONS Breast symptoms show different patterns of change and are not associated with the same factors as arm symptoms. IMPLICATIONS FOR NURSING For nurses monitoring women treated for breast cancer, the results of this study provide knowledge regarding the importance of early symptom identification and long-term symptoms after treatment.
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Bertilsson M, Vaez M, Waern M, Ahlborg G, Hensing G. A prospective study on self-assessed mental well-being and work capacity as determinants of all-cause sickness absence. J Occup Rehabil 2015; 25:52-64. [PMID: 24898192 DOI: 10.1007/s10926-014-9518-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The aim of the present study was to estimate whether self-assessed mental well-being and work capacity determines future sickness absence (SA). METHODS A questionnaire was sent to employed individuals (n = 6,140), aged 19-64 years, who were registered as sick-listed with a new sick-leave spell in 2008. The response rate was 54 %. In this study we included individuals with a single sick-leave spell in 2008 (n = 2,502). The WHO (Ten) Well-Being Index and four dimensions of self-assessed work capacity (knowledge, mental, collaborative, physical) were used as determinants. Future sickness absence was identified through national register in 2009. Outcome was defined as no sickness benefit compensated days (no SBCD) and at least one sickness benefit compensated day (SBCD). Logistic regression analyses were used to estimate odds ratios (OR) with 95 % confidence intervals (CI) for the likelihood of SBCD. RESULTS In 2009, 28 % of the women and 22 % of the men had SBCD; the median was 59 and 66 benefit days, respectively. Individuals with low mental well-being had higher odds for SBCD with OR 1.29 (95 % CI 1.01-1.65) in the fully adjusted model. Participants reporting low work capacity in relation to knowledge (OR 1.55, 95 % CI 1.13-2.13), collaborative (OR 1.36, 95 % CI 1.03-1.79) and physical (OR 1.50, 95 % CI 1.22-1.86) demands at work had higher odds for SBCD after adjustments for all covariates; no relation was demonstrated with mental work capacity (OR 0.99, 95 % CI 0.76-1.27). CONCLUSION Mental well-being and work capacity emerged as determinants of future SA. Screening in health care could facilitate early identification of persons in need of interventions to prevent future SA.
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Affiliation(s)
- M Bertilsson
- Department of Social Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, PO Box 453, 405 30, Göteborg, Sweden,
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Zetterström K, Voss M, Alexanderson K, Ivert T, Pehrsson K, Hammar N, Vaez M. Prevalence of all-cause and diagnosis-specific disability pension at the time of first coronary revascularisation: a population-based Swedish cross-sectional study. PLoS One 2015; 10:e0115540. [PMID: 25629517 PMCID: PMC4309573 DOI: 10.1371/journal.pone.0115540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 11/25/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although coronary revascularisation by coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) is well documented, scientific knowledge on disability pension (DP) at the time of revascularisation is lacking. The aim was to investigate the prevalence of all-cause and diagnosis-specific DP at the time of a first coronary revascularisation, accounting for socio-demographic and medical factors. MATERIALS AND METHODS A population-based cross-sectional study using Swedish registers was conducted including all 65,676 patients (80% men) who when aged 30-63 years, within 1994-2006, had a first CABG (n = 22,959) or PCI (n = 42,717) and did not have old-age pension. Associations between socio-demographic and medical factors and the probability of DP were estimated by odds ratios (OR) with 95% confidence intervals (CI) using logistic regression analyses. FINDINGS The prevalence of DP at time of revascularisation was 24%, mainly due to musculoskeletal diagnoses. Sixty-two percent had had DP for at least four years before the revascularisation. In the multivariable analyses, DP was more common in women (OR: 2.40; 95% CI: 2.29-2.50), older patients (50-63 years); especially men aged 60-63 years with CABG (OR: 4.91; 95% CI: 4.27-5.66), lower educational level; especially men with PCI (OR: 2.96; 95% CI: 2.69-3.26), patients born outside Sweden; especially men with PCI (OR: 2.11; 95% CI: 1.96-2.27), and in women with an indication of other diagnoses than acute coronary syndrome (ACS) or stable angina pectoris for PCI (OR: 1.72; 95% CI: 1.31-2.24). CONCLUSION About a quarter had DP at the time of revascularisation, often due to musculoskeletal diagnoses. More than half had had DP for at least four years before the intervention. DP was associated with female gender, older age, lower educational level, and being born outside Sweden.
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Affiliation(s)
- Katharina Zetterström
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Margaretha Voss
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Analysis and Forecasts, Swedish Social Insurance Agency, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ivert
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Pehrsson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- AstraZeneca R&D, Mölndal, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Zetterström K, Voss M, Alexanderson K, Ivert T, Pehrsson K, Hammar N, Vaez M. Prevalence of all-cause and diagnosis-specific disability pension at the time of first coronary revascularization among women and men in Sweden: A population-based cross-sectional study. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zetterström K, Vaez M, Alexanderson K, Ivert T, Pehrsson K, Hammar N, Voss M. Disability pension after coronary revascularization: a prospective nationwide register-based Swedish cohort study. Eur J Prev Cardiol 2014; 22:304-11. [DOI: 10.1177/2047487313518472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Katharina Zetterström
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ivert
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital and Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Pehrsson
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Hammar
- AstraZeneca R&D, Mölndal, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Margaretha Voss
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Analysis and Forecasts, Swedish Social Insurance Agency, Stockholm, Sweden
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Vaez M, Josephson M, Vingård E, Voss M. Work-related violence and its association with self-rated general health among public sector employees in Sweden. Work 2014; 49:163-71. [DOI: 10.3233/wor-131715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Marjan Vaez
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Malin Josephson
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Vingård
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Margaretha Voss
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Hensing G, Bertilsson M, Ahlborg G, Waern M, Vaez M. Self-assessed mental health problems and work capacity as determinants of return to work: a prospective general population-based study of individuals with all-cause sickness absence. BMC Psychiatry 2013; 13:259. [PMID: 24124982 PMCID: PMC4016129 DOI: 10.1186/1471-244x-13-259] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 10/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health problems are common in the work force and influence work capacity and sickness absence. The aim was to examine self-assessed mental health problems and work capacity as determinants of time until return to work (RTW). METHODS Employed women and men (n=6140), aged 19-64 years, registered as sick with all-cause sickness absence between February 18 and April 15, 2008 received a self-administered questionnaire covering health and work situation (response rate 54%). Demographic data was collected from official registers. This follow-up study included 2502 individuals. Of these, 1082 were currently off sick when answering the questionnaire. Register data on total number of benefit compensated sick-leave days in the end of 2008 were used to determine the time until RTW. Self-reported persistent mental illness, the WHO (Ten) Mental Well-Being Index and self-assessed work capacity in relation to knowledge, mental, collaborative and physical demands at work were used as determinants. Multinomial and binary logistic regression analyses were used to estimate odds ratios with 95% confidence intervals (CI) for the likelihood of RTW. RESULTS The likelihood of RTW (≥ 105 days) was higher among those with persistent mental illness OR= 2.97 (95% CI, 2.10-4.20) and those with low mental well-being OR= 2.89 (95% CI, 2.31-3.62) after adjusting for gender, age, SES, hours worked and sick leave 2007. An analysis of employees who were off sick when they answered the questionnaire, the likelihood of RTW (≥ 105 days) was higher among those who reported low capacity to work in relation to knowledge, mental, collaborative and physical demands at work. In a multivariable analysis, the likelihood of RTW (≥ 105 days) among those with low mental well-being remained significant OR=1.93 (95% CI 1.46-2.55) even after adjustment for all dimensions of capacity to work. CONCLUSION Self-assessed persistent mental illness, low mental well-being and low work capacity increased the likelihood of prolonged RTW. This study is unique because it is based on new sick-leave spells and is the first to show that low mental well-being was a strong determinant of RTW even after adjustment for work capacity. Our findings support the importance of identifying individuals with low mental well-being as a way to promote RTW.
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Affiliation(s)
- Gunnel Hensing
- Department of Social Medicine, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Monica Bertilsson
- Department of Social Medicine, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Gunnar Ahlborg
- Department of Occupational and Environmental Medicine, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
| | - Margda Waern
- Department of and Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Marjan Vaez
- Department of Social Medicine, The Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
- Divisionof Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Nilsson MI, Petersson LM, Wennman-Larsen A, Olsson M, Vaez M, Alexanderson K. Adjustment and social support at work early after breast cancer surgery and its associations with sickness absence. Psychooncology 2013; 22:2755-62. [PMID: 23824596 DOI: 10.1002/pon.3341] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 05/23/2013] [Accepted: 05/27/2013] [Indexed: 11/09/2022]
Abstract
INTRODUCTION As half of the women with breast cancer are of working ages and usually survive, knowledge is needed on how to support them early regarding work-related problems caused by treatments. Most previous studies have focused on individual and disease-related factors, whereas few have focused on work-related factors such as work adjustment and social support. The aim of this study was to investigate received and perceived social support from supervisor and colleagues as well as work adjustments, and their associations with sickness absence, among women who recently had had breast cancer surgery. METHOD Inclusion criteria were as follows: women aged 20-63 years, living in Stockholm County, treated surgically for a first diagnosis of breast cancer, literate in Swedish, without pre-surgical chemotherapy or known distant metastases. Included in the study were 605 women who worked at diagnosis and that had answered a questionnaire within eight weeks of inclusion. Descriptive statistics, univariate, and multivariable logistic regression analyses were applied to estimate odds ratios (OR) with 95% confidence intervals (CI) for the likelihood of being sickness absent. RESULTS Most women perceived and received social support and work adjustment after breast cancer surgery. Low adjustment (OR = 2.14; 95% CI, 1.45-3.18) and less social support (OR = 1.80; 95% CI, 1.16-2.78) were significantly associated with being sickness absent. Adjusting for sociodemographics, strenuous work posture, and treatment did not attenuate these associations. CONCLUSION Adjustment at work and social support from employer are associated with sickness absence and needs to be explored in discussions on return to work after breast cancer surgery.
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Affiliation(s)
- Marie I Nilsson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Voss M, Ivert T, Pehrsson K, Hammar N, Alexanderson K, Nilsson T, Vaez M. Sickness absence following coronary revascularisation. A national study of women and men of working age in Sweden 1994-2006. PLoS One 2012; 7:e40952. [PMID: 22848415 PMCID: PMC3404085 DOI: 10.1371/journal.pone.0040952] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 06/19/2012] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Evidence based and gender specific knowledge about sickness absence following coronary revascularisation is lacking. The objective was to investigate sickness absence after a first coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) among women and men in a national Swedish study. MATERIALS AND METHODS All patients 30-63 years of age, who underwent a first CABG (n = 22,985, 16% women) or PCI (40,891, 22% women) in Sweden between 1994 and 2006 were included. Information on sickness absence, co-morbidity, and other patient characteristics was obtained from national registers. Long-term sickness absence (LTSA) was defined as >180 and >90 sick-leave days in the first sick-leave spell following CABG and PCI, respectively. Prevalence ratio (PR) and 95% confidence interval (CI) of LTSA were calculated. FINDINGS LTSA followed the interventions in 41% and 36% for CABG and PCI patients, respectively. Women had more often LTSA compared with men, (CABG PR = 1.23: 95% CI 1.19-1.28 and PCI PR = 1.19; 95% CI 1.16-1.23). A history of sickness absence the year before the intervention increased the risk for LTSA after the intervention in both genders. Among women, older age, or being self employed or unemployed was associated with a lower risk for LTSA. Among men previous cardiovascular disease, diabetes and low socio-economic position increased the risk. During the observation period, there was no change in sickness absence rates among PCI patients but an increase among CABG patients adjusting for patient characteristics. CONCLUSION This national study covering a 13-year period shows that long-term sickness absence following coronary revascularisation is common in Sweden, especially among women, and is associated with socio-economic position, co-morbidity, and sickness absence during the year before the intervention. Gender specific scientific knowledge about use and effects of sickness absence following coronary revascularisation is warranted for the patients, the treating physicians, the healthcare sector, and the society.
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Affiliation(s)
- Margaretha Voss
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Hensing G, Vaez M, Bertilsson M, Ahlberg Jr G, Waern M. P-586 - Mental illness impacts duration of sickness absence for all psychiatric and somatic diagnoses. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)74753-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Christensson A, Vaez M, Dickman PW, Runeson B. Self-reported depression in first-year nursing students in relation to socio-demographic and educational factors: a nationwide cross-sectional study in Sweden. Soc Psychiatry Psychiatr Epidemiol 2011; 46:299-310. [PMID: 20213328 DOI: 10.1007/s00127-010-0198-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 02/18/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Higher education has been associated with distress and depression in students, and concerns that the proportion students afflicted is increasing have been raised. Findings on student depression have often been based on age-homogeneous samples leaving the results vulnerable to a confounding of student experience, transition from adolescence to adulthood and age on depression. We investigated self-reported depression and its associations with sociodemographic and educational factors in a demographically diverse student population of first-year nursing students in Sweden. METHODS A base-line survey in a nation-wide cohort of 1,700 first-year nursing students was conducted in the fall of 2002. The participants answered a mailed questionnaire containing questions on sociodemography, educational factors, and health. Depression was measured by the Major Depression Inventory and associations to sociodemographic and educational factors were tested in logistic regressions. RESULTS The overall response rate was 72.9%, and 10.2% (5.7% men, 10.7% women) reported depression. Younger age (<30), female gender, immigration from outside of Europe, high workload, dissatisfaction with education, low self-efficacy, and conflicts between personal and college demands were associated with high prevalence of depression. Prior work experience, less need for financial support, and work for pay during term time were related to low prevalence of depression. Older students and those who were parents reported home-college conflicts more often. CONCLUSIONS Nursing students as a group show high levels of self-reported depression but the prevalence is affected by age with a higher proportion depressed among younger students. Even though older students and those who were parents show less depression, they were more vulnerable to home-college conflicts. As older students and parents constitute a large proportion of nursing students, it is of importance to find ways to lessen the effects of the obstacles they encounter in the education.
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Affiliation(s)
- Anna Christensson
- Division of Psychiatry, S.t Göran, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Universitetssjukhuset, Z5:U1, 171 76, Stockholm, Sweden.
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