Intergenerational continuity of loneliness and potential mechanisms: Young Finns Multigenerational Study

Evidence on the intergenerational continuity of loneliness and on potential mechanisms that connect loneliness across successive generations is limited. We examined the association between loneliness of (G0) parents (859 mothers and 570 fathers, mean age 74 years) and their children (G1) (433 sons and 558 daughters, mean age 47 years) producing 991 parent-offspring pairs and tested whether these associations were mediated through subjective socioeconomic position, temperament characteristics, cognitive performance, and depressive symptoms. Mean loneliness across parents had an independent effect on their adult children's experienced loneliness (OR = 1.72, 95% CI 1.23-2.42). We also found a robust effect of mothers' (OR = 1.64, 95% CI 1.17-2.29), but not of fathers' loneliness (OR = 1.47, 95% CI 0.96-2.25) on offspring's experienced loneliness in adulthood. The associations were partly mediated by offspring depressive (41-54%) and anxiety (29-31%) symptoms. The current findings emphasize the high interdependence of loneliness within families mediated partly by offspring's mental health problems.

Effect of weight on depression using multiple genetic instruments

A striking global health development over the past few decades has been the increasing prevalence of overweight and obesity. At the same time, depression has become increasingly common in almost all high-income countries. We investigated whether body weight, measured by body mass index (BMI), has a causal effect on depression symptoms in Finland. Using data drawn from the Cardiovascular Risk in Young Finns Study (N = 1,523, mean age 41.9, SD 5), we used linear regression to establish the relationship between BMI and depression symptoms measured by 21-item Beck's Depression Inventory. To identify causal relationships, we used the Mendelian randomization (MR) method with weighted sums of genetic markers (single nucleotide polymorphisms, SNPs) as instruments for BMI. We employ instruments (polygenic risk scores, PGSs) with varying number of SNPs that are associated with BMI to evaluate the sensitivity of our results to instrument strength. Based on linear regressions, higher BMI was associated with a higher prevalence of depression symptoms among females (b = 0.238, p = 0.000) and males (b = 0.117, p = 0.019). However, the MR results imply that the positive link applies only to females (b = 0.302, p = 0.007) but not to males (b = -0.070, p = 0.520). Poor instrument strength may explain why many previous studies that have utilized genetic instruments have been unable to identify a statistically significant link between BMI and depression-related traits. Although the number of genetic markers in the instrument had only a minor effect on the point estimates, the standard errors were much smaller when more powerful instruments were employed.

The Mediating Role of Digital Competence in the Associations Between the Factors Affecting Healthcare Utilization and Access to Care

Objectives: To examine with a population-based longitudinal survey design whether poor health, longstanding activity limitation, impaired cognitive functioning, mental distress, or loneliness predict poor access to healthcare and whether digital competence mediates these associations. Methods: The data were from the longitudinal FinHealth -survey gathered in Finland in 2017 and 2020 including 3,771 respondents (57.1% women). Linear regression analyses were used to examine the associations of factors affecting healthcare utilization with access to care adjusted for age, sex, and education. Counterfactual causal mediation framework was used to examine the mediating role of digital competence in the relationships among these factors and access to healthcare. Results: Factors affecting healthcare utilization were associated with poor access to care and these associations were partly mediated by low digital competence. Low digital competence mediated 12%, 9% and 8%, of the associations of impaired cognitive functioning, longstanding activity limitation, and loneliness with poor access to care, respectively. Conclusion: According to our results, one way to improve the access to healthcare among vulnerable groups could be to improve their digital competence.

Loneliness and cognitive function in older adults: Longitudinal analysis in 15 countries

This study aims to evaluate the directionality of the association between loneliness and cognitive performance in older adults, accounting for confounding factors. Data were from 55,662 adults aged ≥ 50 years who participated in Waves 5-8 of the Survey of Health, Ageing and Retirement in Europe (SHARE). Loneliness was assessed with the Three-Item Loneliness Scale (TILS) and with a one-item direct question. Cognitive performance was assessed with four measures: verbal fluency, numeracy, immediate recall, and delayed recall. Age, sex, geographical area, educational attainment, partnership status, depressive symptoms, and previous chronic diseases at baseline were used as covariates. We analyzed the associations with three-wave random intercept cross-lagged panel models (RI-CLPM) and conducted age-stratified analysis among those younger versus older than 65 years. Full information maximum likelihood estimators were used to handle missing values in Waves 6-8 in the main analyses. We also conducted additional sensitivity analyses stratified by retirement status (retired vs. not) at baseline. At the within-person level, loneliness and cognitive performance were not associated with each other among those aged 50-64 years in the main time-lagged analysis. Among those aged ≥ 65 years, loneliness was associated with lower cognitive performance in the next wave in all four cognitive domains. In addition, lower verbal fluency predicted greater loneliness in the next waves among this age group. Similar patterns were found independently of retirement status at baseline. These results suggest that loneliness is a psychosocial risk factor for cognitive decline among older adults (≥ 65 years). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Seasonal patterns of sickness absence due to diagnosed mental disorders: a nationwide 12-year register linkage study

AIMS

Although seasonality has been documented for mental disorders, it is unknown whether similar patterns can be observed in employee sickness absence from work due to a wide range of mental disorders with different severity level, and to what extent the rate of change in light exposure plays a role. To address these limitations, we used daily based sickness absence records to examine seasonal patterns in employee sickness absence due to mental disorders.

METHODS

We used nationwide diagnosis-specific psychiatric sickness absence claims data from 2006 to 2017 for adult individuals aged 16-67 (n = 636,543 sickness absence episodes) in Finland, a high-latitude country with a profound variation in daylength. The smoothed time-series of the ratio of observed and expected (O/E) daily counts of episodes were estimated, adjusted for variation in all-cause sickness absence rates during the year.

RESULTS

Unipolar depressive disorders peaked in October-November and dipped in July, with similar associations in all forms of depression. Also, anxiety and non-organic sleep disorders peaked in October-November. Anxiety disorders dipped in January-February and in July-August, while non-organic sleep disorders dipped in April-August. Manic episodes reached a peak from March to July and dipped in September-November and in January-February. Seasonality was not dependent on the severity of the depressive disorder.

CONCLUSIONS

These results suggest a seasonal variation in sickness absence due to common mental disorders and bipolar disorder, with high peaks in depressive, anxiety and sleep disorders towards the end of the year and a peak in manic episodes starting in spring. Rapid changes in light exposure may contribute to sickness absence due to bipolar disorder. The findings can help clinicians and workplaces prepare for seasonal variations in healthcare needs.

Predicting long-term sickness absence with employee questionnaires and administrative records: a prospective cohort study of hospital employees

OBJECTIVE

This study aimed to compare the utility of risk estimation derived from questionnaires and administrative records in predicting long-term sickness absence among shift workers.

METHODS

This prospective cohort study comprised 3197 shift-working hospital employees (mean age 44.5 years, 88.0% women) who responded to a brief 8-item questionnaire on work disability risk factors and were linked to 28 variables on their working hour and workplace characteristics obtained from administrative registries at study baseline. The primary outcome was the first sickness absence lasting ≥90 days during a 4-year follow-up.

RESULTS

The C-index of 0.73 [95% confidence interval (CI) 0.70-0.77] for a questionnaire-only based prediction model, 0.71 (95% CI 0.67-0.75) for an administrative records-only model, and 0.79 (95% CI 0.76-0.82) for a model combining variables from both data sources indicated good discriminatory ability. For a 5%-estimated risk as a threshold for positive test results, the detection rates were 76%, 74%, and 75% and the false positive rates were 40%, 45% and 34% for the three models. For a 20%-risk threshold, the corresponding detection rates were 14%, 8%, and 27% and the false positive rates were 2%, 2%, and 4%. To detect one true positive case with these models, the number of false positive cases accompanied varied between 7 and 10 using the 5%-estimated risk, and between 2 and 3 using the 20%-estimated risk cut-off. The pattern of results was similar using 30-day sickness absence as the outcome.

CONCLUSIONS

The best predictive performance was reached with a model including both questionnaire responses and administrative records. Prediction was almost as accurate with models using only variables from one of these data sources. Further research is needed to examine the generalizability of these findings.

Self-rated work ability as a risk factor for disability retirement

BACKGROUND

Simple and efficient survey measures to predict staying in or leaving work are needed. We examined the association of single-item self-rated work ability (SRWA) with disability retirement in two large population-based samples and compared the association of SRWA to two other scales, work ability score (WAS) and self-rated health (SRH), used earlier in studies.

METHODS

The study population comprised 6034 participants aged 35-58 from the population-based Health 2000 and FinHealth 2017 cohort studies, pooled together. SRWA, WAS and SRH were all classified in three categories: poor, limited and good. A 36-month follow-up for disability retirement via linkage to electronic records was included in the analysis.

RESULTS

Of the participants, 195 retired during the follow-up. All three measures strongly predicted disability retirement. Hazard ratio (HR) for poor SRWA (vs. good) was 8.48 [95% confidence interval (CI) 5.41-13.28], WAS 7.99 (95% CI 5.62-11.37) and SRH 5.96 (95% CI 4.17-8.51). HR for limited SRWA (vs. good) was 4.35 (95% CI 3.21-5.91), WAS 3.54 (95% CI 2.49-5.04) and SRH 2.27 (95% CI 1.59-3.23). Taking into account gender, age, education and mental health narrowed the gap between poor and limited vs. good work ability as predictors of disability retirement, but the differences remained clear.

CONCLUSIONS

Limited or poor self-rated work ability or health are strong predictors of disability retirement. The SRWA measure is a useful survey-measure of work ability in community-based surveys.

Exploring the structure and psychometric properties of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in a representative adult population sample

This article reports the psychometric properties of both full and the abbreviated (Short) Warwick-Edinburgh Mental Well-being Scales (WEMWBS; SWEMWBS) in the Finnish general population. A large cross-sectional dataset (N = 5,335) was collected as part of the nationally representative FinHealth Study in 2017. Exploratory and confirmatory factor analyses of the data evaluated one-, two-, three-, and bi-factorial solutions with a split-half approach. McDonald's omega was used to assess internal consistency and convergent validity was evaluated using four established mental health and well-being scales (BDI-6, GHQ-12, MHI-5, EUROHIS-QOL8). Contrary to previous findings, our results supported a three-factor model of the full scale with separate, yet highly correlated, mental, social, and eudemonic well-being factors. For the SWEMWBS, the bi-factor model showed the best fit, with a strong general mental well-being factor and a weaker specific eudemonic well-being factor. In this sampling context, the social aspect of mental well-being may be considered a separable construct from other mental well-being dimensions and the shorter 7-item version might thus be a preferable option when assessing overall mental well-being.

Nursing informatics competence profiles and perceptions of health information system usefulness among registered nurses: A latent profile analysis

AIMS

To identify different nursing informatics competence (NIC) profiles in nurses, examine the factors associated with profile memberships and examine the associations of the derived profiles with the nurses' perception of the usefulness of a health information system (HIS).

DESIGN

A cross-sectional study.

METHODS

A sample of 3610 registered nurses responded to a nationwide survey in March 2020. A latent profile analysis was performed to identify NIC profiles based on three competence areas: nursing documentation, working in digital environment, and ethics and data protection. A multinomial logistic regression was carried out to examine the associations of demographic and background variables with the profile membership. Linear regression analyses were carried out to examine the association between the profile membership and perceived HIS usefulness.

RESULTS

Three NIC profiles were identified and labelled as low, moderate and high competence groups. A younger age, recent graduation year, sufficient orientation and high-rated proficiency as an HIS user were associated with nurses belonging to a high or moderate competence group relative to a low competence group. Competence group membership was associated with perceived HIS usefulness. The high competence group consistently expressed the highest usefulness of the HIS and the low competence group the lowest.

CONCLUSION

Tailored training and support should be provided for nurses with different levels of informatics competence, thereby facilitating their ability to respond to increasingly digitalized work. This could contribute to higher usefulness of the HIS in terms of supporting the nurses' work tasks and promoting the quality of care.

IMPACT

This was the first study exploring latent profiles of informatics competence in nurses. Insights from this study are useful for nursing management to identify different competence profiles of their employees, provide support and training to meet their needs, and promote the successful use of an HIS.

Psychosocial work characteristics and sleep quality among early career registered nurses: a cross-sectional latent profile analysis

BACKGROUND

Individual psychosocial work characteristics have been associated with health and well-being of registered nurses. However, it is yet to be determined whether different types of psychosocial work characteristics form patterned profiles and how these profiles are associated with the health and well-being. The purpose of this study was to identify latent psychosocial work characteristic profiles, including procedural, interactional and distributive justice, job demand and job control, and examine whether the profiles are associated with sleep quality among early career registered nurses.

METHODS

We conducted a cross-sectional study comprising 632 early career registered nurses. Data were collected between November and December 2018 using an electronic survey with internationally validated measures including the Organizational Justice Scale, the Nurse Stress Index Scale, the Job Content Questionnaire, and the Sleep Problems Questionnaire. Latent profile analysis was used to identify groups with similar psychosocial work characteristic profiles. Multinomial and linear regression analyses were used to examine the association between latent work characteristics profiles and sleep quality.

RESULTS

Analysis yielded four profiles. The profiles were named based on the descriptions of classes as high strain/low justice, medium strain/high justice, medium strain/medium justice, and low strain/high justice. The low strain/high justice profile group (p = < 0.001) and the medium strain/high justice profile group (p = 0.002) had statistically significantly better sleep quality compared to the high strain/low justice profile group.

CONCLUSIONS

High procedural and interactional justice may alleviate strain in early career registered nurses and protect them against sleep problems. Promoting organizational justice in early career stages seems an efficient way to enhance registered nurses' well-being and sleep quality.

Prediction of violence or threat of violence among employees in social work, healthcare and education: the Finnish Public Sector cohort study

OBJECTIVES

To develop a risk prediction algorithm for identifying work units with increased risk of violence in the workplace.

DESIGN

Prospective cohort study.

SETTING

Public sector employees in Finland.

PARTICIPANTS

18 540 nurses, social and youth workers, and teachers from 4276 work units who completed a survey on work characteristics, including prevalence and frequency of workplace violence/threat of violence at baseline in 2018-2019 and at follow-up in 2020-2021. Those who reported daily or weekly exposure to violence or threat of violence daily at baseline were excluded.

EXPOSURES

Mean scores of responses to 87 survey items at baseline were calculated for each work unit, and those scores were then assigned to each employee within that work unit. The scores measured sociodemographic characteristics and work characteristics of the work unit.

PRIMARY OUTCOME MEASURE

Increase in workplace violence between baseline and follow-up (0=no increase, 1=increase).

RESULTS

A total of 7% (323/4487) of the registered nurses, 15% (457/3109) of the practical nurses, 5% of the social and youth workers (162/3442) and 5% of the teachers (360/7502) reported more frequent violence/threat of violence at follow-up than at baseline. The area under the curve values estimating the prediction accuracy of the prediction models were 0.72 for social and youth workers, 0.67 for nurses, and 0.63 for teachers. The risk prediction model for registered nurses included five work unit characteristics associated with more frequent violence at follow-up. The model for practical nurses included six characteristics, the model for social and youth workers seven characteristics and the model for teachers included four characteristics statistically significantly associated with higher likelihood of increased violence.

CONCLUSIONS

The generated risk prediction models identified employees working in work units with high likelihood of future workplace violence with reasonable accuracy. These survey-based algorithms can be used to target interventions to prevent workplace violence.

School achievement in adolescence and the risk of mental disorders in early adulthood: a Finnish nationwide register study

School grades in adolescence have been linked to later psychiatric outcomes, but large-scale nationwide studies across the spectrum of mental disorders are scarce. In the present study, we examined the risk of a wide array of mental disorders in adulthood, as well as the risk of comorbidity, associated with school achievement in adolescence. We used population-based cohort data comprising all individuals born in Finland over the period 1980-2000 (N = 1,070,880) who were followed from age 15 or 16 until a diagnosis of mental disorder, emigration, death, or December 2017, whichever came first. Final grade average from comprehensive school was the exposure, and the first diagnosed mental disorder in a secondary healthcare setting was the outcome. The risks were assessed with Cox proportional hazards models, stratified Cox proportional hazard models within strata of full-siblings, and multinomial regression models. The cumulative incidence of mental disorders was estimated using competing risks regression. Better school achievement was associated with a smaller risk of all subsequent mental disorders and comorbidity, except for eating disorders, where better school achievement was associated with a higher risk. The largest associations were observed between school achievement and substance use disorders. Overall, individuals with school achievement more than two standard deviations below average had an absolute risk of 39.6% of a later mental disorder diagnosis. By contrast, for individuals with school achievement more than two standard deviations above average, the absolute risk of a later mental disorder diagnosis was 15.7%. The results show that the largest mental health burden accumulates among those with the poorest school achievement in adolescence.

Predicting work disability among people with chronic conditions: a prospective cohort study

Few risk prediction scores are available to identify people at increased risk of work disability, particularly for those with an existing morbidity. We examined the predictive performance of disability risk scores for employees with chronic disease. We used prospective data from 88,521 employed participants (mean age 43.1) in the Finnish Public Sector Study including people with chronic disorders: musculoskeletal disorder, depression, migraine, respiratory disease, hypertension, cancer, coronary heart disease, diabetes, comorbid depression and cardiometabolic disease. A total of 105 predictors were assessed at baseline. During a mean follow-up of 8.6 years, 6836 (7.7%) participants were granted a disability pension. C-statistics for the 8-item Finnish Institute of Occupational Health (FIOH) risk score, comprising age, self-rated health, number of sickness absences, socioeconomic position, number of chronic illnesses, sleep problems, BMI, and smoking at baseline, exceeded 0.72 for all disease groups and was 0.80 (95% CI 0.80-0.81) for participants with musculoskeletal disorders, 0.83 (0.82-0.84) for those with migraine, and 0.82 (0.81-0.83) for individuals with respiratory disease. Predictive performance was not significantly improved in models with re-estimated coefficients or a new set of predictors. These findings suggest that the 8-item FIOH work disability risk score may serve as a scalable screening tool in identifying individuals with increased risk for work disability.

Socioeconomic position at the age of 30 and the later risk of a mental disorder: a nationwide population-based register study

BACKGROUND

A study was undertaken to examine the association between multiple indicators of socioeconomic position (SEP) at the age of 30 and the subsequent risk of the most common mental disorders.

METHODS

All persons born in Finland between 1966 and 1986 who were alive and living in Finland at the end of the year when they turned 30 were included. Educational attainment, employment status and personal total income were used as the alternative measures of SEP. Cox proportional hazards models were used to examine the association of SEP at the age of 30 with later risk of mental disorders. Additional analyses were conducted using a sibling design to account for otherwise unobserved shared family characteristics. Competing risks models were used to estimate absolute risks.

RESULTS

The study population included 1 268 768 persons, 26% of whom were later diagnosed with a mental disorder. Lower SEP at age 30 was consistently associated with a higher risk of being later diagnosed with a mental disorder, even after accounting for shared family characteristics and prior history of a mental disorder. Diagnosis-specific analyses showed that the associations were considerably stronger when substance misuse or schizophrenia spectrum disorders were used as an outcome. Absolute risk analyses showed that, by the age of 52 years, 58% of persons who had low educational attainment at the age of 30 were later diagnosed with a mental disorder.

CONCLUSIONS

Poor SEP at the age of 30 is associated with an increased risk of being later diagnosed with a mental disorder.

The mediating effect of psychosocial factors in the relationship between self-organizing teams and employee wellbeing: A cross-sectional observational study

BACKGROUND

Several benefits of working in a self-organizing team, such as higher job satisfaction and better engagement to work have been demonstrated in previous studies.

OBJECTIVE

To examine whether those employees working in a self-organizing team have higher job satisfaction and lower turnover intentions compared to those in non-self-organized teams. Further, to test whether psychosocial factors defined by the Job Demand-Control model would function as mediators.

DESIGN

A cross-sectional survey study.

SETTING(S)

Home care and assisted living facilities (with 24-h assistance).

PARTICIPANTS

Licensed practical nurses (N = 377), registered nurses, therapists and managers (N = 183), and other employees (N = 31) in services for older people.

METHODS

A survey for employees working in services for older people and who were either in the self-organized teams or in the non-self-organized teams. Data was analyzed using linear regression and mediation analyses.

RESULTS

Those employees who worked in a self-organizing team were more satisfied with their job and had lower turnover intentions compared to those in a non-self-organizing team (mean [SD] 3.9 [1.0] vs. 3.7 [1.0], p = 0.006 and 2.2 [1.2] vs. 2.5 [1.3], p = 0.006, respectively). Moreover, job demands and job strain partially mediated the effect of self-organizing teamwork on job satisfaction (Average causal mediation effect [95%CI] 0.09 [0.02-0.15] and 0.10 [0.03-0.18], respectively), as well as on turnover intentions (Average causal mediation effect [95%CI] -0.08 [-0.15 to -0.01] and -0.20 [-0.18 to -0.03], respectively).

CONCLUSIONS

In the context of older people care services, working in self-organizing teams may enhance employee wellbeing by lowering job demands and job strain, but not by improving job control. Based on the findings of this study, self-organization seems beneficial, however, it requires real autonomy for the teams and team building.

TWEETABLE ABSTRACT

Self-organizing teamwork increases job satisfaction and decreases turnover intentions via lower job demands and strain in older people care.

Association between depression and the likelihood of having children: a nationwide register study in Finland

BACKGROUND

Depression may be associated with a lower likelihood of having children, but the findings are inconsistent. Previous population-based studies on this topic are limited.

OBJECTIVE

We examined associations between depression and the likelihood of having children, the number of children, and the parental age at first birth. We also evaluated whether these associations differ for people with low, middle, and high educational levels.

STUDY DESIGN

We conducted a nationwide register cohort study including all individuals born in Finland from 1960 to 1980 (n=1,408,951). Depression diagnoses were identified from the Care Register for Health Care (containing records of inpatient hospital episodes for the period 1969 to 2017 and of specialist outpatient visits for the period 1996 to 2017). The main outcomes-having biological children, the number of biological children, and the parental age at first birth-were identified from the Population Register of Statistics Finland and were defined either in the last year of the follow-up in 2017 or the last year alive or living in Finland. The association between depression and the likelihood of having children was examined using a logistic regression analysis; the association between depression and the number of children was evaluated using Poisson regression analyses, and the association between depression and the age at first birth was evaluated using a linear regression analysis. All analyses were conducted separately for men and women.

RESULTS

For both men and women, secondary care-treated depression was associated with a lower likelihood of having children (odds ratio, 0.66; 95% confidence interval, 0.64-0.67 for men; odds ratio, 0.84; 95% confidence interval, 0.82-0.85 for women) and with having fewer children (incidence rate ratio, 0.86; 95% confidence interval, 0.86-0.87 for men; incidence rate ratio, 0.96; 95% confidence interval, 0.96-0.96 for women). Depression was associated with a slightly lower parental age at first birth (33.1 vs 34.0; P<.001 for men; 31.3 vs 32.1; P<.001 for women). Dose-response associations between the severity of depression and a decreased likelihood of having children, as well as having fewer children, were observed. Earlier onset of depression was related to a lower likelihood of having children and to having fewer children. Among men and women in middle- and high-level educational groups, depression was associated with a lower likelihood of having children and with having fewer children. Among men with a low level of education, no associations were observed. Among women with a low level of education, depression was associated with a higher likelihood of having children and with having more children.

CONCLUSION

Both men and women with secondary care-treated depression have a lower likelihood of having children and have fewer children. Our findings suggest that depression may be one of the factors that contribute to the likelihood of having children, which should be addressed by policy makers.

Association of social isolation and loneliness with risk of incident hospital-treated infections: an analysis of data from the UK Biobank and Finnish Health and Social Support studies

BACKGROUND

Although loneliness and social isolation have been linked to an increased risk of non-communicable diseases such as cardiovascular disease and dementia, their association with the risk of severe infection is uncertain. We aimed to examine the associations between loneliness and social isolation and the risk of hospital-treated infections using data from two independent cohort studies.

METHODS

We assessed the association between loneliness and social isolation and incident hospital-treated infections using data for participants from the UK Biobank study aged 38-73 years at baseline and participants from the nationwide population-based Finnish Health and Social Support (HeSSup) study aged 20-54 years at baseline. For inclusion in the study, participants had to be linked to national health registries, have no history of hospital-treated infections at or before baseline, and have complete data on loneliness or social isolation. Participants with missing data on hospital-treated infections, loneliness, and social isolation were excluded from both cohorts. The outcome was defined as a hospital admission with a primary diagnosis of infection, ascertained via linkage to electronic health records.

FINDINGS

After exclusion of 8·6 million participants for not responding or not providing appropriate consent, the UK Biobank cohort consisted of 456 905 participants (249 586 women and 207 319 men). 26 860 (6·2%) of 436 001 participants with available data were reported as being lonely and 40 428 (9·0%) of 448 114 participants with available data were socially isolated. During a median 8·9 years (IQR 8·0-9·6) of follow-up, 51 361 participants were admitted to hospital due to an infectious disease. After adjustment for age, sex, demographic and lifestyle factors, and morbidities, loneliness was associated with an increased risk of a hospital-treated infection (hazard ratio [HR] 1·12 [95% CI 1·07-1·16]), whereas social isolation was not (HR 1·01 [95% CI 0·97-1·04]). Of 64 797 individuals in the HeSSup cohort, 18 468 (11 367 women and 7101 men) were eligible for inclusion. 4466 (24·4%) of 18 296 were lonely and 1776 (9·7%) of 18 376 socially isolated. During a median follow-up of 10·0 years (IQR 10·0-10·1), 814 (4·4%) participants were admitted to hospital for an infectious disease. The HRs for the HeSSup study replicated those in the UK Biobank (multivariable-adjusted HR for loneliness 1·32 [95% CI 1·06-1·64]; 1·08 [0·87-1·35] for social isolation).

INTERPRETATION

Loneliness might increase susceptibility to severe infections, although the magnitude of this effect appears modest and residual confounding cannot be excluded. Interventional studies are required before policy recommendations can advance.

FUNDING

Academy of Finland, the UK Medical Research Council, and Wellcome Trust UK.

Prediction of bullying at work: A data-driven analysis of the Finnish public sector cohort study

AIM

To determine the extent to which change in (i.e., start and end of) workplace bullying can be predicted by employee responses to standard workplace surveys.

METHODS

Responses to an 87-item survey from 48,537 Finnish public sector employees at T1 (2017-2018) and T2 (2019-2020) were analyzed with least-absolute-shrinkage-and-selection-operator (LASSO) regression. The predictors were modelled both at the individual- and the work unit level. Outcomes included both the start and the end of bullying. Predictive performance was evaluated with C-indices and density plots.

RESULTS

The model with best predictive ability predicted the start of bullying with individual-level predictors, had a C-index of 0.68 and included 25 variables, of which 6 remained in a more parsimonious model: discrimination at work unit, unreasonably high workload, threat that some work tasks will be terminated, working in a work unit where everyone did not feel they are understood and accepted, having a supervisor who was not highly trusted, and a shorter time in current position. Other models performed even worse, either from the point of view of predictive performance, or practical useability.

DISCUSSION

While many bivariate associations between socioeconomic characteristics, work characteristics, leadership, team climate, and job satisfaction were observed, reliable individualized detection of individuals at risk of becoming bullied at workplace was not successful. The predictive performance of the developed risk scores was suboptimal, and we do not recommend their use as an individual-level risk prediction tool. However, they might be useful tool to inform decision-making when planning the contents of interventions to prevent bullying at an organizational level.

Association of short poor work ability measure with increased mortality risk: a prospective multicohort study

OBJECTIVES

To examine whether a single-item measure of self-rated work ability predicts all-cause mortality in three large population-based samples collected in 1978-1980, 2000 and 2017.

SETTING

A representative sample of the population of Finland.

PARTICIPANTS

The study population comprised 17 178 participants aged 18 to 65 from the population-based Mini-Finland, Health 2000 and FinHealth 2017 cohort studies, pooled together. In all cohorts, self-rated work ability was assessed at baseline (1978-80, 2000-2001 and 2017) using three response alternatives: completely fit (good work ability), partially disabled (limited work ability) and completely disabled (poor work ability) for work.

PRIMARY AND SECONDARY OUTCOME MEASURES

All-cause mortality from national registers. Cox proportional hazards models were adjusted for socioeconomic characteristics, lifestyle factors, self-rated health and mental health problems.

RESULTS

Of the participants, 2219 (13%) were classified as having limited and 991 (5.8%) poor work ability and 246 individuals died during the 4 year follow-up. The age- and sex-adjusted HR for mortality risk was 7.20 (95% CI 5.15 to 10.08) for participants with poor vs good work ability and 3.22 (95% CI 2.30 to 4.43) for participants with limited vs good work ability. The excess risk associated with poor work ability was seen in both genders, all age groups, across different educational levels, self-rated health levels and in those with and without mental health problems. The associations were robust to further adjustment for education, health behaviours, self-rated health and mental health problems. In the multivariable analyses, the HR for mortality among those with poor vs good work ability was 5.75 (95% CI 3.59 to 9.20).

CONCLUSIONS

One-item poor self-rated work ability -measure is a strong predictor of increased risk of all-cause mortality and may be a useful survey-measure in predicting severe health outcomes in community-based surveys.

Child Eveningness as a Predictor of Parental Sleep

Child eveningness has been associated with many adverse outcomes for children. The aim of this study was to assess whether child eveningness poses a risk to parental sleep quality in follow-up. A total of 146 children (57% adopted, 47% boys, mean age at follow-up 5.1 years [standard deviation 1.7]) completed a 1-week actigraph recording to analyze their sleep twice, 1 year apart. The parents completed the Child ChronoType Questionnaire for their child and a short version of the Morningness-Eveningness Questionnaire for themselves and the Jenkins Sleep Scale for their sleep quality. Linear regression analyses showed that subjective parental sleeping problems at baseline were associated with subjective parental sleeping problems at follow-up. A morning-type child decreased the risk of parental sleeping problems at the 1-year follow-up compared to the child evening chronotype. Additionally, the child intermediate chronotype decreased the risk of maternal sleeping problems at the 1-year follow-up compared to the evening chronotype of the child. Parents of evening-type children experienced more sleeping problems in the follow-up, compared to parents of morning-type children. This finding encourages parents and professionals to steer the diurnal rhythm of evening-type children toward an earlier daily routine.

Healthcare workers' heterogeneous mental-health responses to prolonging COVID-19 pandemic: a full year of monthly follow up in Finland

BACKGROUND

The COVID-19 pandemic strained healthcare workers but the individual challenges varied in relation to actual work and changes in work. We investigated changes in healthcare workers' mental health under prolonging COVID-19 pandemic conditions, and heterogeneity in the mental-health trajectories.

METHODS

A monthly survey over a full year was conducted for employees of the HUS Helsinki University Hospital (n = 4804) between 4th June 2020 to 28th May 2021. Pandemic-related potentially traumatic events (PTEs), work characteristics (e.g., contact to COVID-19 patients), local COVID-19 incidence, and demographic covariates were used to predict Mental Health Index-5 (MHI-5) and Insomnia Severity Index (ISI) in generalized multilevel and latent-class mixed model regressions.

RESULTS

Local COVID-19 log-incidence (odds ratio, OR = 1.21, with 95% CI = 1.10-1.60), directly caring for COVID-19 patients (OR = 1.33, CI = 1.10-1.60) and PTEs (OR = 4.57, CI = 3.85-5.43) were all independently associated with psychological distress, when (additionally) adjusting for age, sex, profession, and calendar time. Effects of COVID-19 incidence on mental health were dissociable from calendar time (i.e., evolved in time) whereas those on sleep were not. Latent mental-health trajectories were characterized by a large class of "stable mental health" (62% of employees) and minority classes for "early shock, improving" (14%) and "early resilience, deteriorating" mental health (24%). The minority classes, especially "early shock, improving", were more likely to live alone and be exposed to PTEs than the others.

CONCLUSIONS

Healthcare workers faced changing and heterogeneous mental-health challenges as the COVID-19 pandemic prolonged. Adversity and mental ill-being may have accumulated in some employees, and factors like living arrangements may have played a role. Knowledge on employees' demographic and socioeconomic background, as well as further research on the factors affecting employees' resilience, may help in maintaining healthy and efficient workforce in the face of a prolonging pandemic.

Climatic exposures in childhood and the risk of schizophrenia from childhood to early adulthood

BACKGROUND

Season of birth is a risk factor of schizophrenia, and it is possible that cumulative exposure to climatic factors during childhood affects the risk of schizophrenia. We conducted a cohort study among 365,482 persons born in Finland in 1990-1995 to examine associations of 10-year cumulative exposure to global solar radiation and ambient temperature in childhood with schizophrenia.

METHODS

Data on schizophrenia diagnoses and sociodemographic factors from the Finnish population register and health care register were linked to daily meteorological data using residential information. The study population was followed from age 10 until the first schizophrenia diagnosis, death, emigration or December 31, 2017, whichever came first. Hazard ratios (HR) for the risk of schizophrenia were estimated using Cox proportional hazards model.

RESULTS

Compared to the lowest quintile of global solar radiation or ambient temperature, growing up in the second highest quintile (Q4) was associated with greater risk of schizophrenia. These hazard ratios were attenuated after adjustment for parental mental disorder, parental education, parental income, area-level socioeconomic characteristics and urbanicity (HR = 1.29, 95 % CI 1.06-1.58 for radiation; HR = 1.24, 95 % CI, 1.02-1.52 for temperature). Continuous linear terms evaluated in secondary models suggested a greater risk of schizophrenia at greater childhood exposure to global radiation and ambient temperature, but these associations did not remain in fully adjusted models.

CONCLUSIONS

We found no consistent evidence that cumulative exposure to sunlight and ambient temperature in childhood is associated with the risk of developing schizophrenia. Studies in other populations residing in different latitudes are needed.

Changes in healthy and unhealthy working life expectancies among older working-age people in Finland, 2000-2017

Background

Raising the statutory retirement age has been a common policy response to population ageing, but health problems may restrict labour force participation in older ages. We examined the development of healthy and unhealthy working life expectancies in Finland from 2000 to 2017 using different measures of health problems.

Methods

Healthy and unhealthy working life expectancies were calculated for the age range 50–65 years using the Sullivan method. The health measures were limiting long-standing illness, self-rated health, mental health problems and self-assessed work ability.

Results

Healthy working life expectancy was highest when health was measured by work ability. From 2000 to 2017, working years in full ability between the ages 50–65 increased from 6.2 (95% confidence interval 5.9–6.4) to 8.2 (8.0–8.5). Healthy working life expectancy increased also when measured by the other indicators. Unhealthy working years also increased, except when health problems were measured by limiting long-standing illness. The share of years in work increased both within the healthy and the unhealthy years, the increase being larger or equally large for the latter. Within the healthy and unhealthy years measured by the other three indicators, the share of working years increased irrespective of whether work ability was full or limited, but the increase was larger for limited work ability.

Conclusions

In Finland, healthy working life expectancy has increased irrespective of how health is measured but also working with health problems has become more prevalent. The estimates for healthy working years are highest when a direct measure of work ability is used.

The Interplay of Work, Digital Health Usage, and the Perceived Effects of Digitalization on Physicians' Work: Network Analysis Approach

Background

In health care, the benefits of digitalization need to outweigh the risks, but there is limited knowledge about the factors affecting this balance in the work environment of physicians. To achieve the benefits of digitalization, a more comprehensive understanding of this complex phenomenon related to the digitalization of physicians’ work is needed.

Objective

The aim of this study was to examine physicians’ perceptions of the effects of health care digitalization on their work and to analyze how these perceptions are associated with multiple factors related to work and digital health usage.

Methods

A representative sample of 4630 (response rate 24.46%) Finnish physicians (2960/4617, 64.11% women) was used. Statements measuring the perceived effects of digitalization on work included the patients’ active role, preventive work, interprofessional cooperation, decision support, access to patient information, and faster consultations. Network analysis of the perceived effects of digitalization and factors related to work and digital health usage was conducted using mixed graphical modeling. Adjusted and standardized regression coefficients are denoted by b. Centrality statistics were examined to evaluate the relative influence of each variable in terms of node strength.

Results

Nearly half of physicians considered that digitalization has promoted an active role for patients in their own care (2104/4537, 46.37%) and easier access to patient information (1986/4551, 43.64%), but only 1 in 10 (445/4529, 9.82%) felt that the impact has been positive on consultation times with patients. Almost half of the respondents estimated that digitalization has neither increased nor decreased the possibilities for preventive work (2036/4506, 45.18%) and supportiveness of clinical decision support systems (1941/4458, 43.54%). When all variables were integrated into the network, the most influential variables were purpose of using health information systems, employment sector, and specialization status. However, the grade given to the electronic health record (EHR) system that was primarily used had the strongest direct links to faster consultations (b=0.32) and facilitated access to patient information (b=0.28). At least 6 months of use of the main EHR was associated with facilitated access to patient information (b=0.18).

Conclusions

The results highlight the complex interdependence of multiple factors associated with the perceived effects of digitalization on physicians’ work. It seems that a high-quality EHR system is critical for promoting smooth clinical practice. In addition, work-related factors may influence other factors that affect digital health success. These factors should be considered when developing and implementing new digital health technologies or services for physicians’ work. The adoption of digital health is not just a technological project but a project that changes existing work practices.

Comparison of two different mindfulness interventions among health care students in Finland: a randomised controlled trial

We investigated the short- and long-term effects of two different evidence-based mindfulness training on students' stress and well-being. A randomised controlled trial with three measurement points (baseline, post-intervention, and 4 months post-intervention) was conducted among undergraduate students of medicine, dentistry, psychology, and logopaedics at the University of Helsinki. The participants were randomly assigned into three groups: (1) face-to-face mindfulness training based on the Mindfulness Skills for Students course (n = 40), (2) a web-based Student Compass program using Mindfulness and Acceptance and Commitment therapy (n = 22), and (3) a control group that received mental health support as usual (n = 40). The primary outcome was psychological distress measured using the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). Secondary outcomes included hair cortisol concentrations and a wide range of well-being indicators. Psychological distress increased in all the groups from baseline to post-intervention, but significantly less so in the intervention groups than in the control group. At 4-month follow-up, were found no differences between the primary outcomes of the control and intervention groups, but the participants who continued practising mindfulness at least twice a week were less stressed than the others. Our results suggest that participating in a mindfulness course may mitigate health care students' psychological distress during the academic year, but only if the participants continue practising mindfulness at least twice a week.

Psychosocial work environment as a dynamic network: a multi-wave cohort study

While characteristics of psychosocial work environment have traditionally been studied separately, we propose an alternative approach that treats psychosocial factors as interacting elements in networks where they all potentially affect each other. In this network analysis, we used data from a prospective occupational cohort including 10,892 participants (85% women; mean age 47 years) and repeated measurements of seven psychosocial work characteristics (job demands, job control, job uncertainty, team climate, effort-reward imbalance, procedural justice and interactional justice) assessed in 2000, 2004, 2008 and 2012. Results from multilevel longitudinal vector autoregressive models indicated that job demands as well as interactional and procedural justice were most broadly associated with the subsequent perceptions of the work-related psychosocial factors (high out-Strength), suggesting these factors might be potentially efficient targets of workplace interventions. The results also suggest that modifying almost any of the studied psychosocial factors might be relevant to subsequent perceptions of effort-reward imbalance and interactional justice at the workplace.

Associations of long-term solar insolation with specific depressive symptoms: Evidence from a prospective cohort study

Evidence suggests that sunlight counteracts depression, but the associations of long-term sunlight exposure with specific symptoms of depression are not well known. We evaluated symptom-specific associations of average 1-year solar insolation with DSM-5 depressive symptoms in a representative cohort of Finnish adults. The sample included 1,845 participants from the Cardiovascular Risk in Young Finns Study with data on DSM-5 depressive symptoms, place of residence and covariates. Daily recordings of global solar radiation were obtained from the Finnish Meteorological Institute. Each participant's residential zip code on each day one year prior to the assessment of depressive symptoms was linked to the solar radiation data, and 1-year average daily solar insolation was calculated. Associations of the average 1-year solar insolation with depressive symptoms were assessed with linear and logistic regression analyses adjusting for season, sex, age, as well as individual- and neighborhood-level socioeconomic characteristics. Average daily solar insolation over one year prior to the depressive symptom assessment was not associated with the total number of depressive symptoms reported by participants. In symptom-specific analyses, participants exposed to higher levels of solar insolation in their residential neighborhood were less likely to report suicidal thought (OR = 0.61, 95% CI, 0.39-0.94), and more likely to report changes in appetite (OR = 1.24, 95% CI, 1.00-1.54), changes in sleep (OR = 1.30, 95% CI, 1.06-1.59) and feelings of worthlessness/guilt (OR = 1.33, 95% CI = 1.07-1.65). These findings suggest that solar insolation may contribute to symptom-specific differences in depression. Studies in other populations residing in different geographical locations are needed.

The association between stress attributed to information systems and the experience of workplace aggression: a cross-sectional survey study among Finnish physicians

Background

Physicians commonly suffer from workplace aggression and its negative consequences. Previous studies have shown that stressors such as job demands increase the risk of inappropriate treatment at workplace. Poorly functioning, and constantly changing information systems form a major work stressor for physicians. The current study examined the association between physicians’ stress attributed to information systems (SAIS) and their experiences of workplace aggression. Workplace aggression covered physical and non-physical aggression, perpetrated by coworkers, patients, patient’s relatives, or supervisors.

Methods

A cross-sectional survey study was conducted. The participants included 2786 physicians (67.4% women) who were sampled randomly from the registry of Finnish Medical Association, which covers almost all of the Finnish physician population. First, bivariate associations were studied among participant characteristics, SAIS and workplace aggression. Logistic regression analysis was then used to further determine how SAIS was associated with the likelihood of experiencing different types of aggression.

Results

Higher levels of SAIS were associated with higher likelihood of aggression with regard to all types of aggression, except non-physical aggression perpetrated by patients or relatives. The demographic factors (work-sector, gender, age) did not have a noticeable influence on the association between SAIS and aggression.

Conclusions

The present results build on previous evidence on the prevalence of SAIS and its negative effects on healthcare workers. Since SAIS may increase the risk of experiencing aggression, it is possible that SAIS also endangers the wellbeing of physicians and thereby the quality of patient care. Resourcing time and training during introduction of a new IS could alleviate time pressure and thus stress attributed to managing new information systems. The role of organizational climate and general workload in arousing SAIS and aggression should be examined in future studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08116-w.

Parental psychological problems were associated with higher screen time and the use of mature-rated media in children

Aim

Parents’ psychological problems may affect children's screen time, but research has been scarce. We examined the association between parental psychological problems and children's screen media behaviours in a nationally representative sample.

Methods

The participants were from the Adolescent Brain Cognitive Development study, recruited by probability sampling from the USA population. Children reported their use of TV, videos, video games, social media and mature‐rated media. The parents (85% mothers) reported psychological problems using the Adult Self‐Report questionnaire.

Results

In 10,650 children (5112 girls, 5538 boys) aged 9.9 ± 0.6 years, the presence of parental psychological problems was associated with children spending more daily time on screen media and with meeting the recommendation of ≤2 daily hours less often than children whose parents did not have psychological problems. Parental psychological problems were associated with children's TV watching, video watching and gaming but not with using social media. Parental internalising problems were associated with children watching mature‐rated movies (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.00, 1.30) and playing mature‐rated games (OR = 1.27, 95% CI = 1.11, 1.45).

Conclusion

Presence of parental psychological problems is associated with higher screen time and use of mature‐rated media in children. This cross‐sectional study was not able to examine causal associations.

Association of social isolation, loneliness and genetic risk with incidence of dementia: UK Biobank Cohort Study

BACKGROUND

Social isolation and loneliness have been associated with increased risk of dementia, but it is not known whether this risk is modified or confounded by genetic risk of dementia.

METHODS

We used the prospective UK Biobank study with 155 070 participants (mean age 64.1 years), including self-reported social isolation and loneliness. Genetic risk was indicated using the polygenic risk score for Alzheimer's disease and the incident dementia ascertained using electronic health records.

RESULTS

Overall, 8.6% of participants reported that they were socially isolated and 5.5% were lonely. During a mean follow-up of 8.8 years (1.36 million person years), 1444 (0.9% of the total sample) were diagnosed with dementia. Social isolation, but not loneliness, was associated with increased risk of dementia (HR 1.62, 95% CI 1.38 to 1.90). There were no interaction effects between genetic risk and social isolation or between genetic risk and loneliness predicting incident dementia. Of the participants who were socially isolated and had high genetic risk, 4.4% (95% CI 3.4% to 5.5%) were estimated to developed dementia compared with 2.9% (95% CI 2.6% to 3.2%) of those who were not socially isolated but had high genetic risk. Comparable differences were also in those with intermediate and low genetic risk levels.

CONCLUSIONS

Socially isolated individuals are at increased risk of dementia at all levels of genetic risk.

Subjective mental well-being among higher education students in Finland during the first wave of COVID-19

Aims:

Increased mental health problems during the COVID-19 pandemic have become a major concern among young adults. Our aim was to understand which COVID-19-related questions predicted mental well-being during the outbreak.

Methods:

Two cross-sectional datasets were used. The primary dataset was collected in May 2020 (n = 1001), during the initial COVID-19 outbreak, and the secondary in April 2019 (n = 10866), before the pandemic. Mental well-being was assessed with the Short Warwick–Edinburgh Mental Well-Being Scale. Relationships between mental well-being and COVID-19-related questions were investigated with lasso regression. As an exploratory analysis, two-way ANOVAs were used to compare mental well-being before and during the outbreak.

Results:

Higher levels of mental well-being were associated with lower levels of academic stress and COVID-19-related worry, along with a higher satisfaction with the procedures and information provided by the higher education institutions and the government. COVID-19-related symptoms and infections did not have an impact on students’ mental well-being during the outbreak. Small to moderate effect sizes across the time points were detected, indicating an overall decrease in mental well-being across age and gender during the outbreak.

Conclusions:

COVID-19 had an impact on higher education students’ mental well-being. Higher education institutes may play a crucial role in protecting their students’ well-being during uncertain times.

Changes in objectively measured sleep among internationally adopted children in 1-year follow-up during the first years in new families

BACKGROUND

Psychosocial risks and environmental changes experienced by internationally adopted children may predict sleep problems, which are incidentally among the main concerns of adoptive parents. Several questionnaire studies have found sleep of internationally adopted children to be problematic, but none of those used an objective measure in a controlled study.

OBJECTIVE

To determine whether the objectively recorded sleep of internationally adopted children is worse than their controls who are living with their biological parents.

METHODS

To this case-control part of the Finnish Adoption Study, we recruited children who were adopted internationally to Finland between October 2012 and December 2016. Simultaneously, control children were recruited from 16 daycare centers. To assess sleep in children, actigraphy recordings were made twice, 1 year apart, between December 2013 and April 2018. In the adopted group, the first assessment took place 10 months after they had arrived in their families. The associations between adoption status and sleep parameters were analyzed using linear mixed modeling and adjusted for multiple potential confounders, including child age.

RESULTS

Seventy-eight internationally adopted children (boys 64%) aged 1-7 years and 99 controls (boys 53%) aged 2-6 years attended the first sleep recording. The recordings showed that the internationally adopted children slept longer (B = 0.48, 95% CI 0.23-0.73, P < 0.001) than the controls. There were no significant differences in sleep fragmentation or sleep efficiency between the groups. During the 1-year follow-up, the sleep patterns of the adopted children approached those of the controls.

CONCLUSIONS

The internationally adopted children spent more time in bed and slept more than their control children in both recordings. However, their sleep patterns were not very different from those of their peers and the differences appeared to vanish during the first years in their new family.

The relative importance of work-related psychosocial factors in physician burnout

Background

Identifying the most significant risk factors for physician burnout can help to define the priority areas for burnout prevention. However, not much is known about the relative importance of these risk factors.

Aims

This study was aimed to examine the relative importance of multiple work-related psychosocial factors in predicting burnout dimensions among physicians.

Methods

In a cross-sectional sample of 2423 Finnish physicians, dominance analysis was used to estimate the proportionate contribution of psychosocial factors to emotional exhaustion, depersonalization and reduced personal accomplishment. The psychosocial factors included job demands (time pressure, patient-related stress, lack of support, stress related to information systems, work–family conflict) and job resources (job control, team climate, organizational justice).

Results

Together, psychosocial factors explained 50% of the variance in emotional exhaustion, 24% in depersonalization and 11% in reduced professional efficacy. Time pressure was the most important predictor of emotional exhaustion (change in total variance explained ΔR² = 45%), and patient-related stress was the most important predictor of both depersonalization (ΔR² = 52%) and reduced professional accomplishment (ΔR² = 23%). Stress related to information systems was the least important predictor of the burnout dimensions (ΔR² = 1–2%).

Conclusions

Psychosocial factors in physicians’ work are differently associated with the dimensions of burnout. Among the factors, the most significant correlates of burnout are job demands in the form of time pressure and patient-related stress.

Long-term cumulative light exposure from the natural environment and sleep: A cohort study

We analysed (A) the association of short-term as well as long-term cumulative exposure to natural light, and (B) the association of detailed temporal patterns of natural light exposure history with three indicators of sleep: sleep duration, sleep problems, and diurnal preference. Data (N = 1,962; 55% women; mean age 41.4 years) were from the prospective Young Finns Study, which we linked to daily meteorological data on each participant's neighbourhood natural light exposure using residential postal codes. Sleep outcomes were self-reported in 2011. We first examined associations of the sleep outcomes with cumulative light exposure of 5-year, 2-year, 1-year, and 2-month periods prior to the sleep assessment using linear and Poisson regression models adjusting for potential confounders. We then used a data-driven time series approach to detect clusters of participants with different light exposure histories and assessed the associations of these clusters with the sleep outcomes using linear and Poisson regression analyses. A greater cumulative light exposure over ≥1 year was associated with a shorter sleep duration (β = -0.10, 95% confidence interval [CI] -0.15 to -0.04), more sleep problems (incident rate ratio [IRR] 1.04, 95% CI 1.0-1.07) and diurnal preference towards eveningness (β = -0.09, 95% CI -0.14 to -0.03). The data-driven exposure pattern of "slowly increasing" light exposure was associated with fewer overall sleep problems (IRR 0.93, 95% CI 0.88-0.98) compared to a "recently declining" light exposure group representing the "average-exposure" group. These findings suggest that living in an area with relatively more intense light exposure for a longer period of time influences sleep.

Presleep physiological stress is associated with a higher cortical arousal in sleep and more consolidated REM sleep

How sleep regulates physiological stress in healthy individuals is not well understood. We explored the associations between naturally occurring pre-sleep physiological arousal and EEG power spectral density together with rapid eye movement sleep (REMS) continuity. One hundred and fifty-four individuals (mean age 16.9, SD 0.1 years) collected five samples of saliva between the evening (mean time 18:20) and bedtime (mean 23:00) by using swabs, and underwent an overnight in-home polysomnography. We calculated spectral density for REMS and non-rapid eye movement sleep (non-REMS), and the number and duration of REMS arousals (<15 s) during sleep. An observational design allowed for measurement of natural variation in physiological and sleep arousal. Increasing cortisol levels toward bedtime were associated with higher EEG power spectral density at all frequency ranges in frontal locations, the highest association being for the beta1 frequency band. In central locations, the associations were pronounced for beta1 and beta2 bands. Higher overall cortisol levels in the evening were associated with less fragmented REMS. Presleep arousal was not associated with sleep staging. Physiological arousal toward bedtime was associated with EEG power spectral density values during sleep specifically at high EEG frequencies. This may represent a compensatory mechanism that serves as an adaptation to stress, since the REMS was more continuous along a higher physiological arousal level in the evening. Although causality cannot be inferred, a design with nonmanipulated physiological stress followed by naturally timed sleep at home provides new insights into stress regulation homeostasis.

Hospital-treated infectious diseases and the risk of dementia: a large, multicohort, observational study with a replication cohort

BACKGROUND

Infections have been hypothesised to increase the risk of dementia. Existing studies have included a narrow range of infectious diseases, relied on short follow-up periods, and provided little evidence for whether the increased risk is limited to specific dementia subtypes or attributable to specific microbes rather than infection burden. We aimed to compare the risk of Alzheimer's disease and other dementias across a wide range of hospital-treated bacterial and viral infections in two large cohorts with long follow-up periods.

METHODS

In this large, multicohort, observational study, the analysis was based on a primary cohort consisting of pooled individual-level data from three prospective cohort studies in Finland (the Finnish Public Sector study, the Health and Social Support study, and the Still Working study) and an independent replication cohort from the UK Biobank. Community-dwelling adults (≥18 years) with no dementia at study entry were included. Follow-up was until Dec 31, 2012, in the Health and Social Support study, Dec 31, 2016, in the public sector study and the Still Working study, and Feb 7, 2018, in the replication cohort. Through record linkage to national hospital inpatient registers, we ascertained exposure to 925 infectious diseases (using the International Classification of Diseases 10th Revision codes) before dementia onset, and identified incident dementia from hospital records, medication reimbursement entitlements, and death certificates. Hazard ratios (HRs) for the associations of each infectious disease or disease group (index infection) with incident dementia were assessed by use of Cox proportional hazards models. We then repeated the analysis after excluding incident dementia cases that occurred during the first 10 years after initial hospitalisation due to the index infection.

FINDINGS

From March 1, 1986, to Jan 1, 2005, 260 490 people were included in the primary cohort, and from Dec 19, 2006, to Oct 1, 2010, 485 708 people were included in the replication cohort. In the primary cohort analysis based on 3 947 046 person-years at risk (median follow-up 15·4 years [IQR 9·8-21·0]), 77 108 participants had at least one hospital-treated infection before dementia onset and 2768 developed dementia. Hospitalisation for any infectious disease was associated with increased dementia risk in the primary cohort (adjusted HR [aHR] 1·48 [95% CI 1·37-1·60]) and replication cohort (2·60 [2·38-2·83]). The association remained when analyses were restricted to new dementia cases that occurred more than 10 years after infection (aHR 1·22 [95% CI 1·09-1·36] in the primary cohort, the replication cohort had insufficient follow-up data for this analysis), and when comorbidities and other dementia risk factors were considered. There was evidence of a dose-response association between the number of episodes of hospital-treated infections and dementia risk in both cohorts (ptrend=0·0007). Although the greatest dementia risk was seen for central nervous system (CNS) infections versus no infection (aHR 3·01 [95% CI 2·07-4·37]), excess risk was also evident for extra-CNS infections (1·47 [1·36-1·59]). Although we found little difference in the infection-dementia association by type of infection, associations were stronger for vascular dementia than for Alzheimer's disease (aHR 2·09 [95% CI 1·59-2·75] versus aHR 1·20 [1·08-1·33] in the primary cohort and aHR 3·28 [2·65-4·04] versus aHR 1·80 [1·53-2·13] in the replication cohort).

INTERPRETATION

Severe infections requiring hospital treatment are associated with long-term increased risk of dementia, including vascular dementia and Alzheimer's disease. This association is not limited to CNS infections, suggesting that systemic effects are sufficient to affect the brain. The absence of infection specificity combined with evidence of dose-response relationships between infectious disease burden and dementia risk support the hypothesis that increased dementia risk is driven by general inflammation rather than specific microbes.

FUNDING

UK Medical Research Council, US National Institute on Aging, Wellcome Trust, NordForsk, Academy of Finland, and Helsinki Institute of Life Science.

Is symptom connectivity really the most important issue in depression? Depression as a dynamic system of interconnected symptoms revisited

According to the network theory strong associations between symptoms drive the disease process. We compared those with and without diagnosed depressive disorders (DD+/DD-) and analysed the effects of differences in (a) network connectivity, (b) symptom thresholds, and (c) autoregressive loops (i.e. how strongly specific symptoms predict themselves) on the potential activation of symptoms over time using simulations developed by Cramer and others (2016). The parameters for the simulation (symptom connectivity and symptom threshold) were obtained from Ising models and cross-lagged panel network analyses. Data were from the nationally representative samples (Health 2000-2011 Study) of 4190 participants measured in 2011 (cross-sectional analyses) and 3201 participants measured in 2000 and 2011 (longitudinal analyses). DD diagnosis was based on the Composite International Diagnostic Interview and depressive symptoms were self-reported using the 13-item version of the Beck Depression Inventory (BDI). Differences in symptom connectivity between participants with and without DD were not observed, but the mean probability (threshold) of symptom existence in the DD + group was higher than in the DD-group (0.41 vs. 0.12). Simulation showed that there are more active symptoms in the DD + group after 10 000 time points (means 1.2 vs. 4.6) than in the DD-group. This difference largely disappeared when we used longitudinal networks, including autoregressive loops, in the connectivity matrix. Our results suggest that the differences in symptom thresholds and autoregressive loops may be more important features than symptom connectivity in differentiating people with and without DD.

The effects of maternal depression on their perception of emotional and behavioral problems of their internationally adopted children

BACKGROUND

Even though child psychopathology assessment guidelines emphasize comprehensive multi-method, multimodal, and multi-informant methodologies, maternal-report symptom-rating scales often serve as the predominant source of information. Research has shown that parental mood symptomatology affects their reports of their offspring's psychopathology. For example, the depression-distortion hypothesis suggests that maternal depression promotes a negative bias in mothers' perceptions of their children's behavioral and emotional problems. We investigated this difference of perception between adoptive mothers and internationally adopted children. Most previous studies suffer from the potential bias caused by the fact that parents and children share genetic risks.

METHODS

Data were derived from the Finnish Adoption (FinAdo) survey study (a subsample of adopted children aged between 9 and 12 years, n = 222). The Child Behavior Checklist (CBCL) was used to assess emotional and behavioral problems and competences of the adopted children. The CBCL was filled in by the adopted children and the adoptive mothers, respectively. Maternal depressive symptoms were measured using the short version of the General Health Questionnaire.

RESULTS

On average, mothers reported less total CBCL symptoms in their children than the children themselves (0.25 vs 0.38, p-value < 0.01 for difference). Mothers' depressive symptoms moderated the discrepancy in reporting internalizing symptoms (β = - 0.14 and p-value 0.01 for interaction) and the total symptoms scores (β = - 0.22 and p-value < 0.001 for interaction) and externalizing symptoms in girls in the CBCL.

LIMITATIONS

The major limitation of our study is its cross-sectional design and the fact that we only collected data in the form of questionnaires.

CONCLUSIONS

The results of our research support the depression-distortion hypothesis concerning the association of maternal depressive symptoms and child internalizing symptoms and externalizing symptoms in girls in a sample without genetic bias.

Clinical symptoms of anxiety disorders as predictors of political attitudes: A prospective cohort study

Conservative political ideologies have been suggested to correlate with elevated sensitivity to threat. However, it is unclear whether the associations between threat sensitivity and political attitudes can be observed with clinical measures of mental health. We examined how anxiety disorders predicted attitudes on several political issues. Participants were 7253 individuals from the 1958 British Birth Cohort study. Symptoms of generalised anxiety disorder, phobia and panic were assessed in a clinical interview at age 44, and opinions about political issues were self-reported by the participants 6 years later. Anxiety symptoms were associated with higher concerns about economic inequality, preservation of the environment, distrust in politics and lower work ethic. No associations were observed with racist or authoritarian attitudes, or support for traditional family values. We also assessed how political attitudes at ages 33 and 42 predicted anxiety disorder symptoms at age 44, revealing a possible bidirectional association between concern for economic inequality and anxiety disorder symptoms. These findings do not support an association between conservative political attitudes and elevated threat sensitivity. Rather, elevated anxiety may increase concerns about social inequality and the environment.

Data-driven modelling approach to circadian temperature rhythm profiles in free-living conditions

The individual variation in the circadian rhythms at the physiological level is not well understood. Albeit self-reported circadian preference profiles have been consolidated, their premises are grounded on human experience, not on physiology. We used data-driven, unsupervised time series modelling to characterize distinct profiles of the circadian rhythm measured from skin surface temperature in free-living conditions. We demonstrate the existence of three distinct clusters of individuals which differed in their circadian temperature profiles. The cluster with the highest temperature amplitude and the lowest midline estimating statistic of rhythm, or rhythm-adjusted mean, had the most regular and early-timed sleep–wake rhythm, and was the least probable for those with a concurrent delayed sleep phase, or eveningness chronotype. While the clusters associated with the observed sleep and circadian preference patterns, the entirely unsupervised modelling of physiological data provides a novel basis for modelling and understanding the human circadian functions in free-living conditions.

Living alone as a risk factor for cancer incidence, case-fatality and all-cause mortality: A nationwide registry study

Lack of social contacts has been associated with an increased risk of cancer mortality, but it is not known whether living alone increases the risk of cancer incidence or case fatality. We examined the association between living alone with cancer incidence, case-fatality and all-cause mortality in eight most common cancers. All patients with their first cancer diagnosis in 2000–2017 were identified from the nationwide Finnish Cancer Registry. Information on living arrangements was derived from Statistics Finland. The incidence analyses were conducted using Poisson regression. The total Finnish population served as the population at risk. Fine-Gray model was used to estimate case-fatality and Cox proportional regression model all-cause mortality. In men, we found an association between history of living alone and excess lung cancer incidence but living alone seemed to be associated with lower incidence of prostate cancer and skin melanoma. In women, living alone was more consistently associated with higher incidence of all studied cancers. Cancer patients living alone had an 11%–80% statistically significantly increased case-fatality and all-cause mortality in all studied cancers in men and in breast, colorectal and lung cancer in women. Living alone is consistently associated with increased cancer incidence risk in women but only in some cancers in men. Both men and women living alone had an increased risk of all-cause mortality after cancer diagnosis.

•

We studied the effect of living alone on cancer incidence and mortality in total Finnish population.

•

Excess cancer incidence risk was only found consistently in women.

•

We found persistent excess cancer-specific mortality in cancer patients living alone.

•

Cancer patients living alone had also a higher all-cause mortality risk.

•

Further studies should study pathways to care among socially isolated individuals.

Organizational justice among registered nurses: A scoping review

AIMS

This study aimed to describe and summarize research concerning organizational justice among registered nurses.

BACKGROUND

Over the recent decades, a number of studies have explored organizational justice. Perceived high organizational justice among employees has been found to correlate with multiple beneficial outcomes, such as job satisfaction, commitment and improved physical and mental health. By contrast, low organizational justice is related to poor productivity, atmosphere at work, health and well-being.

DESIGN

This study is a scoping review.

DATA

Seven databases were used to search for peer-reviewed publications published between January 2015 and August 2019.

REVIEW METHOD

This scoping review utilized Arksey and O'Malley's methodological framework.

RESULTS

High organizational justice has been found to improve registered nurses' work-related outcomes, health and well-being. Low organizational justice has been linked to undesired work-related outcomes and health problems.

CONCLUSION

Nurse managers play a key role in promoting organizational justice. Further research is needed to study the relationship between organizational justice and the quality of patient care and safety. There is need for longitudinal studies to understand the effects and nature of organizational justice in the nursing workforce.

A longitudinal study of changes in interactional justice and subsequent short-term sickness absence among municipal employees

Objectives Level of perceived interactional justice has been shown to be associated with sickness absence, but less is known about the effects of changes in interactional justice. It is also unknown to what extent unmeasured, time-invariant differences contribute to the association. We investigated the association between interactional justice changes and subsequent short-term (1-3 days) sickness absences over a 12-year follow-up using between- and within-individual modeling among ageing municipal employees. Methods The data was derived from Helsinki Health Study cohort with baseline survey in 2000-2002 (N=8960, response rate 67%) and follow-up surveys in 2007 and 2012 (response rates 79% and 83%, respectively). At baseline, participants were 40-60-year-old employees of the City of Helsinki, Finland. Sickness absences from the employer's registry were linked with the responses (78%). The analytic sample was 2109 and 2070 individuals for between-individual and 4433 individuals and 8425 observations for within-individual associations. Results Negative change in interactional justice was associated with an increased risk of short-term sickness absence in between-individual models after adjusting for age and gender. Adjustment for sickness absence history attenuated the association. In within-individual models, a negative change in perceived interactional justice was associated with an increased risk of short-term sickness absence spells [incidence rate ratios (IRR) 1.05 (95% confidence interval 1.01-1.09)]. This association was robust to adjustments for gender, age, health behaviors and sickness absence history. Conclusions Paying attention to management principles - especially managerial behavior and treatment of employees to avoid the deterioration of the level of interactional justice - may provide a way of reducing self-certified short-term sickness absence spells.

Use of Health Services and Unmet Need among Adults of Russian, Somali, and Kurdish Origin in Finland

Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional data from a random sample of persons of Russian (n = 692), Somali (n = 489), and Kurdish (n = 614) origin and the Health 2011 survey data (n = 1406) representing the general population in Finland. Having at least one outpatient visit to any medical doctor during the previous 12 months was at the same level for groups of Russian and Kurdish origin, but lower for people of Somali origin, compared with the general population. Clear differences were found when examining where health care services were sought: people of migrant origin predominantly visited a doctor at municipal health centers whereas the general population also used private and occupational health care. Self-reported need for doctor's treatment was especially high among Russian women and Kurdish men and women. Compared to the general population, all migrant origin groups reported much higher levels of unmet medical need and were less satisfied with the treatment they had received. Improving basic-level health services would serve besides the population at large, the wellbeing of the population of migrant origin.

Early childhood psychosocial family risks and cumulative dopaminergic sensitizing score: Links to behavior problems in U.S. 9-year-olds

BACKGROUND

We examined, (a) whether in early childhood exposure to risky family environment in different domains (socioeconomic, mental, parenting practices, health behavior, and child-related risks) and accumulatively across various domains (cumulative risk) is associated with child's problem behavior at age 9, and (b) whether the association is more pronounced in children carrying cumulative dopaminergic sensitizing genotype or living in low-income families.

METHODS

Participants were 2,860 9-year old children (48% females; 48% Black) and their mothers from the 'Fragile Families and Child Wellbeing Study', a probability birth cohort from large U.S. cities. Mothers responded to questions on child's problem behavior (CBCL). Children responded to questions about their vandalism and substance use.

RESULTS

Cumulative family risk was associated with higher internalizing and externalizing behavior and higher vandalism and substance use. All domain-specific risk clusters were associated with higher internalizing behavior and, with the exception of child-related risk, with higher externalizing behavior. Mental health risks, risky parenting practices, and risky health behavior were associated with higher vandalism. Risky parenting practices were associated with higher substance use. The associations were robust to adjustment for cumulative dopaminergic sensitizing genotype. No G x E interactions with dopaminergic genotype and family SES were observed.

LIMITATIONS

Sample size was relatively small for genetic analysis and polygenic risk scores were not available.

CONCLUSIONS

Exposure to cumulative psychosocial family risks from early childhood is associated with early indicators of problem behavior in adolescence.

Is moderate depression associated with sleep stage architecture in adolescence? Testing the stage type associations using network and transition probability approaches

BACKGROUND

Depression even at the subclinical level is often accompanied by sleep disturbances, but little is known about the dynamics of the sleep stages in relation to depressive symptoms. We examined whether the amount, associations, and transition probabilities of various sleep stages were associated with depressive symptoms in a community sample of adolescents.

METHODS

The participants (N = 172, 59% girls, mean age 16.9 years) underwent overnight polysomnography and provided data on depressive symptoms (Beck Depression Inventory II). The association between depression status and total duration of each stage type was analyzed using ANOVA and survival analyses. The associations between the number of different sleep stage types were analyzed using graphical Gaussian models, mixed graphical models, and relative importance networks. A Markov chain algorithm was used to estimate the transition probabilities between each state and these probabilities were further compared between depression status groups.

RESULTS

The associations between N1 and N3 were significantly stronger in both directions of the association (p-values for interactions 0.012 and 0.006) in those with more depressive symptoms. Similarly, a stronger association was observed from N1 to wake stage in those with more depressive symptoms (p-value for interaction 0.002). In those with more depressive symptoms, it was more likely to transition from N2 to N3 and from REM to N2 compared to others.

CONCLUSIONS

These findings indicate that changes in sleep architecture are not limited to clinical depression and that the transitional dynamics of sleep stages are an important marker of subclinical depression.

Longitudinal associations between specific symptoms of depression: Network analysis in a prospective cohort study

BACKGROUND

Network perspective to mental disorders suggests that depression develops due to interrelated associations between individual symptoms rather than due to a common cause. However, it is unclear whether long-term longitudinal associations between specific symptoms of depression demonstrate coherent patterns. We examined the temporal sequences and changes in depressive symptoms over time, and whether some symptoms are more central than others in inducing changes in the rest of the symptoms over time. We also compared the network structure of depressive symptoms between people who were and were not taking medication for depression or anxiety.

METHODS

Data were from the Survey of Health, Aging and Retirement in Europe, with five follow-ups conducted between 2004 and 2017. Participants who had data on depressive symptoms from at least two study waves were analyzed (n = 72,971). Depressive symptoms were self-reported using the 12-item EURO-D scale.

RESULTS

All individual symptoms were longitudinally associated with each other. Changes in sad or depressed mood, diminished interest, and suicidal ideation were the most strongly associated with changes in other symptoms. There were no consistent differences in symptom associations between individuals taking versus not taking psychotropic medication.

LIMITATIONS

Depressive symptoms were self-reported and measured every two years, which may dilute some short-term temporal sequences of the symptoms.

CONCLUSIONS

Our findings demonstrate differences between depressive symptoms in their long-term associations with other depressive symptoms in the general population. Changes in sad or depressed mood, diminished interest, and suicidal ideation have the strongest associations with changes in the rest of the symptoms.

Dynamic fluctuations of emotional states in adolescents with delayed sleep phase-A longitudinal network modeling approach

BACKGROUND

Very late sleep rhythms are risks for social adjustment problems in adolescence. Using ecological momentary assessment data, we quantified and visualized temporal and contemporaneous within-persons dynamical relations of sleepiness and emotions in adolescents with and without late sleep rhythms.

METHODS

We analyzed a temporal network via multilevel vector autoregression (mlVAR) modeling and a contemporaneous network through the partial associations between the residuals of temporal and the between-subject multilevel models. We tested whether these networks were different between those with a late circadian rhythm [concurrent delayed sleep phase (DSP) N = 172, 37% boys, 63% girls] and those without (N = 143, 22% boys, 78% girls).

RESULTS

In adolescents without DSP, the temporal networks showed continuity only for low mood from the previous to the following time point. In adolescents with DSP, there were more predictable patterns of emotions. Feelings of depression led to a decrease of positive emotions and increase of irritation and anxiety. The contemporaneous networks showed clusters of positive and negative emotions in both groups and sleepiness decreased the experience of positive emotions concurrently.

LIMITATIONS

DSP in our current study was based only on one out of three diagnostic criteria of the full disorder (DSM-5) and it was assessed only once.

CONCLUSIONS

These findings indicate that the dynamic organization of emotions and sleepiness is different in adolescents with and without DSP. DSP adolescents have more predictable and maladaptive emotional patterns during the day. Results provide new insight about why individuals with DSP are at a heightened risk for decreased emotional adjustment.

Employment and earnings trajectories before and after sickness absence due to major depressive disorder: a nationwide case-control study

OBJECTIVES

To examine employment and earnings trajectories before and after the first sickness absence period due to major depressive disorder (MDD).

METHODS

All individuals (n=158 813) in Finland who had a first sickness absence period (lasting longer than 9 days) due to MDD between 2005 and 2015 were matched with one randomly selected individual of the same age and gender with no history of MDD. Employment status and earnings were measured using register-based data annually from 2005 to 2015. Generalised estimating equations were used to examine the trajectories of employment and earnings before and after MDD diagnosis in men and women separately.

RESULTS

Sickness absence due to MDD was associated with increased probability of non-employment during and after the year of the first sickness absence period. In men, but not in women, the probability of being employed was lower 5 years before the sickness absence period due to MDD. When compared with the individuals in the control group, men had around 34% and women 15% lower earnings 1 year, and 40% and 23%, respectively, 5 years, after the first sickness absence period due to MDD. More severe MDD and longer duration of sickness absence period were associated with lower probability of being employed.

CONCLUSIONS

Sickness absence due to MDD was associated with considerable reduction in employment and earnings losses. For men and individuals with more severe MDD, this reduction was before the first sickness period. This supports a reciprocal association between employment and earnings with MDD.