There are inherent methodological challenges in the measurement of mental health problems in longitudinal research. There is constant development in definitions, taxonomies and demands concerning the properties of mental health measurements. The aim of this paper was to construct composite measures of mental health problems (according to today's standard) from single questionnaire items devised in the early 1980s, and to evaluate their internal consistency and factorial invariance across the life course using the Northern Swedish Cohort.
All pupils in the last year of compulsory school in Luleå in 1981 (n?=?1083) form a prospective cohort study where the participants have been followed with questionnaires from the age of 16 (in 1981) until the age of 43 (in 2008). We created and tested the following composite measures from self-reports at each follow-up: depressive symptoms, anxiety symptoms, functional somatic symptoms, modified GHQ and positive health. Validity and internal consistency were tested by confirmatory factor analysis, including tests of factorial invariance over time.
As an overall assessment, the results showed that the composite measures (based on more than 30-year-old single item questions) are likely to have acceptable factorial invariance as well as internal consistency over time.
Testing the properties of the mental health measures used in older studies according to the standards of today is of great importance in longitudinal research. Our study demonstrates that composite measures of mental health problems can be constructed from single items which are more than 30 years old and that these measures seem to have the same factorial structure and internal consistency across a significant part of the life course. Thus, it can be possible to overcome some specific inherent methodological challenges in using historical data in longitudinal research.
Despite the reported success of Lean in health care settings, it is unclear why and how organizations adopt Lean and how Lean transforms work design and, in turn, affects employees' work. This study investigated a cardiology department's journey to adopt and adapt Lean. The investigation was focused on the rationale and evolution of the Lean adoption to illuminate how a department with a long quality improvement history arrived at the decision to introduce Lean, and how Lean influenced employees' daily work. This is an explanatory single case study based on semistructured interviews, nonparticipant observations, and document studies. Guided by a Lean model, we undertook manifest content analysis of the data. We found that previous improvement efforts may facilitate the introduction of Lean but may be less important when forecasting whether Lean will be sustained over time. Contextual factors seemed to influence both what Lean tools were implemented and how well the changes were sustained. For example, adoption of Lean varied with the degree to which staff saw a need for change. Work redesign and teamwork were found helpful to improve patient care whereas problem solving was found helpful in keeping the staff engaged and sustaining the results over time.
Although depression is common, prevalence estimates of antidepressant use among the workforce and undisputed evidence relating psychosocial work characteristics to depression is scarce. This study cross-sectionally assesses the prevalence of antidepressant use among employed in Sweden and Denmark and prospectively examines associations between work characteristics and antidepressant use.
Data on work demands, influence and learning possibilities was collected 2005-2006 from two representative samples of employed aged 20-59 years from Sweden (n=4351) and Denmark (n=8064) and linked to purchases of antidepressants through national prescription drug registries. Standardized 12-month prevalences were calculated. Cox regressions on work characteristics and incident use were performed separately and estimates pooled.
Employed Swedish residents had higher standardized prevalence than Danish, 6.0% compared to 5.0%. Working fast and conflicting demands were associated with incident use when estimates were pooled, but adjustment for baseline health attenuated these estimates. Emotionally disturbing situations were related to any incident use, and more strongly to use >179 defined daily dosages/year, even after adjustment for various covariates.
Statistics based on national prescription drug registries are influenced by, e.g., treatment seeking behaviours and other reasons for prescription than depression. Selective drop-out may also affect prevalence estimates.
The study indicates that use of antidepressants among the workforce is relatively high and that employed Swedish residents had higher prevalence of antidepressant use than Danish. Relationships between work characteristics and antidepressant use were, however, similar with emotional demands showing the strongest association, indicating that particular groups of employees may be at increased risk.
We examined the associations of contractual job insecurity (fixed-term vs permanent employment contract) and subjectively assessed job insecurity with sickness presenteeism among those who had no sickness absences during the study year.
Survey data from a sample of 18,454 Public sector employees were gathered in 2004 (the Finnish Public Sector study).
Fixed-term employees were less likely to report working while ill (odds ratio = 0.88, 95% confidence interval = 0.77 to 0.99) than permanent employees. Subjective insecurity was associated with higher levels of working while ill, and this association was stronger among older employees. These results remained after adjustments for demographics, health-related variables, and optimism.
Our results suggest that subjective job insecurity might be even more important than contractual insecurity when a public sector employee makes the decision to go to work despite feeling ill.
The aim of this study was to investigate whether shift work (with or without night work) is associated with increased risk of breast cancer.
The population consisted of 4036 women. Data were obtained from WOLF (Work, Lipids, and Fibrinogen), a longitudinal cohort study. Information about baseline characteristics was based on questionnaire responses and medical examination. Cancer incidence from baseline to follow-up was obtained from the national cancer registry. Two exposure groups were identified: shift work with and without night work. The group with day work only was used as the reference group in the analysis. Cox regression analysis was used to calculate relative risk.
In total, 94 women developed breast cancer during follow-up. The average follow-up time was 12.4 years. The hazard ratio for breast cancer was 1.23 [95% confidence interval (95% CI) 0.70-2.17] for shifts without night work and 2.02 (95% CI 1.03-3.95) for shifts with night work. When including only women
BACKGROUND: The combination of population ageing and increasingly early labour market exit (LME) throughout Europe has made older age a key issue in social policy and research. There is increasing awareness that older people are a heterogeneous group in which health inequalities persist. However, the effects of different types of LME on health have received relatively little attention. Existing studies reach different conclusions. This might be due to several reasons: different types of LME are rarely explored in conjuncture; studies often lack objective assessments of health and frequently rely on small populations. This paper aims to test the relative effects of different LME on the risk of hospitalization compared with those who remained in paid employment. METHODS: Using Government register data on pooled cross-section samples of Swedish workers aged 55-63 years (n=7,024) the authors have compared the likelihood of hospitalization for three types of LME - disability pension (fortidpension), unemployment, and early retirement - with those who continue working. RESULTS: Controlling for previous hospitalization, sex, age, social class, and health at work a significant increased risk of hospitalization was found following LME for the unemployed (OR=1.98). CONCLUSION: Early LME is a varied process with mixed effects on health, and hence is of possible importance for policy, which, therefore, requires more attention. Programmes to help older unemployed workers back into work will have positive health effects for individuals and reduce welfare costs of hospitalization.
Thirty-two female participants in a mobilising labour market programme offering temporary, alternative employment in Sweden were followed longitudinally for one year, including a six month post participation follow-up period. It can be hypothesised that an important aspect of the physiological effects of unemployment is a change in the balance between anabolic and catabolic activities in the body and that re-employment should lead to a shift towards anabolism. An earlier study of a smaller subset of the data, however, including both men and women, showed increased prolactin and decreased dehydroepiadrosterone sulphate (DHEA-s) levels, contrary to the initial hypothesis. In the present analysis, intended to elucidate these results, psychophysiological data were summarised in two indices, one connected with anabolism (made up of testosterone and DHEA-s) and one with catabolism (prolactin, gamma-glutamyl transferase, aspartate amino transferase, alpha levuline amino transferase, and body mass index). In addition, self-rated anxiety, depression, hopelessness and personal control were analysed. The results indicate that the effect of 'better' activities within the programme was a temporary increase in anabolism, possibly indicating lower stress levels, and the effect of 'worse' activities, on the one hand, a temporary decrease in the catabolic index, probably reflecting repressed alcohol consumption, and, on the other hand, impaired anabolism. There was also a general but transient decrease in depressiveness measured by the Hospital Anxiety and Depression Scale. The results seem to imply that it is difficult to achieve lasting effects through a relatively short participation in a mobilising programme.
OBJECTIVE To evaluate the cross-cultural validity of the Demand-Control Questionnaire, comparing the original Swedish questionnaire with the Brazilian version. METHODS We compared data from 362 Swedish and 399 Brazilian health workers. Confirmatory and exploratory factor analyses were performed to test structural validity, using the robust weighted least squares mean and variance-adjusted (WLSMV) estimator. Construct validity, using hypotheses testing, was evaluated through the inspection of the mean score distribution of the scale dimensions according to sociodemographic and social support at work variables. RESULTS The confirmatory and exploratory factor analyses supported the instrument in three dimensions (for Swedish and Brazilians): psychological demands, skill discretion and decision authority. The best-fit model was achieved by including an error correlation between work fast and work intensely (psychological demands) and removing the item repetitive work (skill discretion). Hypotheses testing showed that workers with university degree had higher scores on skill discretion and decision authority and those with high levels of Social Support at Work had lower scores on psychological demands and higher scores on decision authority. CONCLUSIONS The results supported the equivalent dimensional structures across the two culturally different work contexts. Skill discretion and decision authority formed two distinct dimensions and the item repetitive work should be removed.
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Sleep problems are experienced by a large part of the population. Work characteristics are potential determinants, but limited longitudinal evidence is available to date, and reverse causation is a plausible alternative. This study examines longitudinal, bidirectional relationships between work characteristics and sleep problems.
Prospective cohort/two-wave panel.
3065 working men and women approximately representative of the Swedish workforce who responded to the 2006 and 2008 waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH).
Bidirectional relationships between, on the one hand, workplace demands, decision authority, and support, and, on the other hand, sleep disturbances (reflecting lack of sleep continuity) and awakening problems (reflecting feelings of being insufficiently restored), were investigated by structural equation modeling. All factors were modeled as latent variables and adjusted for gender, age, marital status, education, alcohol consumption, and job change. Concerning sleep disturbances, the best fitting models were the "forward" causal model for demands and the "reverse" causal model for support. Regarding awakening problems, reciprocal models fitted the data best.
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Few studies have examined depression as both a cause and effect of unemployment, but no prior work investigated these relationships in the context of organisational downsizing. We explored whether the exposure to downsizing is associated with subsequent depression (social causation), and whether pre-existing depression increases the risk of being laid off when organisations downsize (health selection).
Two successive waves of the nationally representative Swedish Longitudinal Occupational Survey of Health represented the baseline (2008) and follow-up (2010) of this study. Analyses included 196 workers who lost their jobs through downsizing, 1462 layoff survivors remaining in downsized organisations and 1845 employees of non-downsized workplaces. The main outcomes were: (1) Depressive symptoms at follow-up, assessed with a brief subscale from the Symptom Checklist 90, categorised by severity levels ("major depression", "less severe symptoms" and "no depression") and analysed in relation to earlier downsizing exposure; (2) Job loss in persons with downsizing in relation to earlier depressive symptoms. The associations were assessed by means of multinomial logistic regression.
Job loss consistently predicted subsequent major depression among men and women, with a somewhat greater effect size in men. Surviving a layoff was significantly associated with subsequent major depression in women but not in men. Women with major depression have increased risks of exclusion from employment when organisations downsize, whereas job loss in men was not significantly influenced by their health.
The evidence from this study suggests that the relative importance of social causation and health selection varies by gender in the context of organisational downsizing. Strategies for handling depression among employees should be sensitive to gender-specific risks during layoffs. Policies preventing social exclusion can be important for female workers at higher risk of depression.
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