| 1. |
- Alaie, Iman, et al.
(författare)
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Associations of Internalizing and Externalizing Problems in Childhood and Adolescence With Adult Labor Market Marginalization
- 2023
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 6:6
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Mental health problems in early life are associated with labor market marginalization, especially in youths with persistent internalizing and externalizing problems. However, previous research has not adjusted for familial (genetic and shared environmental) factors.OBJECTIVE To examine associations of early-life internalizing and externalizing problems with adulthood unemployment and work disability, adjusting for familial factors.DESIGN, SETTING, AND PARTICIPANTS This population-based prospective cohort study included Swedish twins whowere born in 1985-1986 and surveyed at 4 consecutivewaves across childhood and adolescence until 2005. Through linkage to nationwide registries, participants were followed up from 2006 to 2018. Data analyses were conducted between September 2022 and April 2023.EXPOSURES Internalizing and externalizing problems, assessed with the Child Behavior Checklist. Participants were differentiated regarding duration of internalizing and externalizing problems (persistent, episodic, and noncases).MAIN OUTCOMES AND MEASURES Unemployment (180 days or more of being unemployed) and work disability (60 days or more of being sickness absent or disability pensioned) during follow-up. Cox proportional hazards regression models were calculated to obtain cause-specific hazard ratios (HRs) with 95% CIs in the whole cohort and exposure-discordant twin pairs.RESULTS Of 2845 participants, 1464 (51.5%) were female. Incident unemployment was experienced by 944 (33.2%) and incidentwork disability by 522 (18.3%) participants. Compared with noncases, persistent internalizing problemswere associated with unemployment (HR, 1.56; 95% CI, 1.27-1.92) and work disability (HR, 2.32; 95% CI, 1.80-2.99). Similarly, compared with noncases, persistent externalizing problems were associated with unemployment (HR, 1.87; 95% CI, 1.55-2.26) andwork disability (HR, 2.38; 95% CI, 1.87-3.03). Persistent cases had overall higher risks of adverse outcomes than episodic cases. After adjustment for familial factors, associations with unemployment were no longer statistically significant, whereas associations with work disability remained or were only slightly reduced.CONCLUSIONS AND RELEVANCE In this cohort study of young Swedish twins, familial factors explained the associations between early-life persistent internalizing and externalizing problems and unemployment; such factors were comparatively less important for the association with work disability. This suggests nonshared environmental factors may be important for the risk of future work disability among young individuals with persistent internalizing and externalizing problems.
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| 2. |
- Alaie, Iman, et al.
(författare)
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Longitudinal trajectories of sickness absence among young adults with a history of depression and anxiety symptoms in Sweden
- 2023
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Ingår i: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 339, s. 271-279
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Tidskriftsartikel (refereegranskat)abstract
- Background: Depression and anxiety are associated with increased risk of sickness absence (SA), yet the developmental patterns of SA remain unclear. We aimed to identify trajectories of SA in young adults with depression and/or anxiety, accounting for sociodemographic and occupational factors.Methods: Longitudinal study of 1445 twin individuals with elevated depressive/anxiety symptoms in late adolescence or young adulthood (age range: 19-30), assessed in Swedish surveys completed in 2005. Through linkage to nationwide registries, individuals were prospectively followed from 2006 to 2018. The outcome included consecutive annual days of SA, which were analyzed using group-based trajectory modeling. Multinomial logistic regression estimating odds ratios (OR) with 95 % confidence intervals (CI) was used to examine associations of age, sex, and educational level with the resulting SA trajectories.Results: Four distinct SA trajectories were identified in the total sample: 'high-increasing' (6 %), 'low-increasing' (12 %), 'high-decreasing' (13 %), and 'low-constant' (69 %). Increasing age was associated with higher odds of belonging to the low-increasing trajectory (OR = 1.07, 95 % CI = 1.02-1.12). Women had higher odds of belonging to the low-increasing trajectory (OR = 1.67, 95 % CI = 1.10-2.53), compared with men. Higher education was associated with lower odds of belonging to high-increasing (OR = 0.34, 95 % CI = 0.22-0.54) and high-decreasing (OR = 0.59, 95 % CI = 0.43-0.81) trajectories, compared with lower education. Few differences were observed in analyses stratified by occupational sector.Limitations: Information on potential confounders (e.g., psychiatric comorbidity, work-environment factors) was not available.Conclusions: Among young adults with prior depression/anxiety, close to every fifth showed rising SA trajectories over time. This calls for targeted strategies to improve public mental health already at young ages.
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| 3. |
- Björkenstam, Emma, et al.
(författare)
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Associations between childbirth, hospitalization and disability pension : a cohort study of female twins
- 2014
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: As the literature on long-term effects of childbirth on risk of morbidity or permanent work incapacity (DP) is limited, we aimed to study associations of childbirth with hospitalization and DP, adjusting for familial factors.METHODS: This cohort study included female twins, i.e. women with twin sister, born 1959-1990 in Sweden (n = 5 118). At least one in the twin pair had their first childbirth 1994-2009. Women were followed regarding all-cause and cause-specific (mental or musculoskeletal diagnoses) DP during year 2-5 after first delivery or equivalent. Associations between childbirth, hospitalization and DP were calculated as hazard ratios (HR) with 95% confidence intervals (CI).RESULTS: Women who did not give birth had markedly higher number of DP days/year compared to those giving birth. Hospitalization after first childbirth was associated with a higher HR of DP. Those hospitalized at least once after their first childbirth had a three-fold DP risk (HR: 3.2; 95% CI 1.1-9.6), DP due to mental diagnoses (HR: 3.2; 1.2-8.8), and of DP due to musculoskeletal diagnoses (HR: 6.1; 1.6-22.9). Lower HRs in the discordant twin pair analyses indicated that familial factors may influence the studied associations.CONCLUSIONS: Women who did not give birth had a much higher risk for DP than those who did. Among those who gave birth, the risk for DP was markedly higher among those with a previous hospitalization, and especially in women with repeated hospitalizations. The results indicate a health selection into giving birth as well as the importance of morbidity for DP.
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| 4. |
- Björkenstam, Emma, et al.
(författare)
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Childbirth, hospitalisation and sickness absence : a study of female twins
- 2015
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate associations of giving birth with morbidity in terms of hospitalisation and social consequences of morbidity in terms of sickness absence (SA), while taking familial (genetics and shared environmental) factors into account.DESIGN: Prospective register-based cohort study. Estimates of risk of hospitalisation and SA were calculated as HRs with 95% CIs.SETTING: All female twins, that is, women with a twin sister, born in Sweden.PARTICIPANTS: 5118 Swedish female twins (women with a twin sister), born during 1959-1990, where at least one in the twin pair had their first childbirth (T0) during 1994-2009 and none gave birth before 1994.MAIN OUTCOME MEASURES: Hospitalisation and SA during year 3-5 after first delivery or equivalent.RESULTS: Preceding the first childbirth, the mean annual number of SA days increased for mothers, and then decreased again. Hospitalisation after T0 was associated with higher HRs of short-term and long-term SA (HR for short-term SA 3.0; 95% CI 2.5 to 3.6 and for long-term SA 2.3; 95% CI 1.6 to 3.2). Hospitalisation both before and after first childbirth was associated with a higher risk of future SA (HR for long-term SA 4.2; 95% CI 2.7 to 6.4). Familial factors influenced the association between hospitalisation and long-term SA, regardless of childbirth status.CONCLUSIONS: Women giving birth did not have a higher risk for SA than those not giving birth and results indicate a positive health selection into giving birth. Mothers hospitalised before and/or after giving birth had higher risks for future SA, that is, there was a strong association between morbidity and future SA.
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| 5. |
- Helgadóttir, Björg, et al.
(författare)
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The role of occupational class on the association between sickness absence and disability pension : A Swedish register-based twin study
- 2019
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 45:6, s. 622-630
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this study was to examine the association between long-term sickness absence (LTSA) due to mental disorders and musculoskeletal disorders and all-cause disability pension (DP) among blue- and white-collar workers. A secondary objective was to examine the influence of familial factors on the associations. Methods This was a prospective twin cohort study of 42 984 individuals (21-64 years at baseline), 3017 of whom had a new LTSA spell (>14 days) due to mental or musculoskeletal disorders in 2005-2006. Average follow-up time was 5.4 years. Survey data on occupational class and register data on LTSA and DP were used. Cox proportional hazards regression was applied to calculate hazards ratios (HR) with 95% confidence intervals (CI). Results During follow-up, 989 participants went on disability. LTSA due to mental disorders and musculoskeletal disorders led to similar HR for DP among both white- and blue-collar workers when compared to white-collar workers not on LTSA (reference group). LTSA >= 6 months due to musculoskeletal disorders was associated with a higher risk of DP for white-collar (HR 31.50, 95% CI 20.45-48.52) than blue-collar (HR 17.64, 95% CI 13.08-23.78) workers when compared to the reference group. HR were lower in the discordant twin pair models for LTSA due to mental disorders than in the whole cohort. Conclusions White-collar workers on LTSA due to musculoskeletal disorders are especially vulnerable to all-cause DP. This pattern was not present for LTSA due to mental disorders. Familial factors seem to influence the association between LTSA due to mental disorders and all-cause DP.
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| 6. |
- Helgadóttir, Björg, et al.
(författare)
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Transitioning from sickness absence to disability pension - the impact of poor health behaviours : a prospective Swedish twin cohort study.
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:11
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate the association between three poor health behaviours (current smoker, high consumption of alcohol and low physical activity levels) and the transition to disability pension (DP) among individuals who have recently been sickness absent. Furthermore, we aimed to explore whether having multiple poor health behaviours increased the risk of transitioning from sickness absence (SA) to DP.DESIGN: Prospective twin cohort study.SETTING: Sweden.PARTICIPANTS: Twins aged 20-46 who had participated in a survey and been on SA (>14 days) in the year preceding baseline (date of answering the questionnaire).MAIN OUTCOME MEASURE: Incident DP during the follow-up which ended on 31 December 2012 (mean 5.2 years). A national register with full coverage provided data on DP.RESULTS: The Cox proportional-hazards regression analyses showed that current smokers had a higher risk of transitioning from SA to DP compared with never smokers (HR 1.76; 95% CI 1.08 to 2.84). Alcohol use and lack of physical activity as well as poor health behaviour sum score showed no significant associations.CONCLUSIONS: Being a current smoker influences the transition from SA to DP. Although non-significant, there were indications that more physical activity and fewer poor health behaviours could reduce the risk of exiting the labour market through DP. Improving health behaviours among people on SA could be a valuable tool for preventing the transition to DP.
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| 7. |
- Magnusson Hanson, Linda, 1977-, et al.
(författare)
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Work-related violence or harassment and sickness absence due to common mental disorders : A prospective twin study
- 2023
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Ingår i: <em>Innovation in Aging</em>, Volume 7, Issue Supplement_1, December 2023. - : Oxford University Press. ; , s. 1152-1153
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Konferensbidrag (refereegranskat)abstract
- The aim of the present study was to investigate the association between exposure to unacceptable behaviors and practices or threats thereof in working life that result in or aim to result in physical, psychological, sexual or economic harm, such as violence and harassment including unwelcome conduct based on e.g. sex or gender (gender-based harassment/discrimination), and future sickness absence due to common mental disorders among Swedish twins. The study included 8795 twins, from the Swedish Study of Twin Adults: Genes and Environment, asked to report exposure to work-related violence or threats of violence and harassment or bullying and whom were followed-up for certified sickness absence (min 12 years of follow-up). Standard logistic regression indicated that exposure increased the odds of sickness absence due to common mental disorders (adjusted OR 2.11; 95% CI 1.52-2.95 for violence/threats, adjusted OR 1.52; 95% CI 1.10-2.11 for harassment/bullying). A co-twin control analyses based on conditional logistic regression restricted to twin pairs discordant for exposure, in which a co-twin control was used as reference, however, resulted in attenuated ORs (2.0; 0.79-5.07 and 1.56; 0.66-3.66, respectively). This indicates that the relationships could be at least partially confounded by familial factors, such as genetics and shared environment. These results suggests that more work is needed to clarify whether there is a causal association between these types of unacceptable behaviors/practices and mental health outcomes considering familial/genetic factors, and whether prevention of such behaviors/practices can keep individuals increasingly healthy, active on the labor market and promote healthy aging.
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| 8. |
- Malm, Andreas
(författare)
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Post-migration stress and mental health among refugees : a population-based survey among refugees from Syria recently resettled in Sweden
- 2021
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Refugees are exposed to several risk factors for mental ill health before, during, and after the migration. While the impact of traumatic experiences on the mental health of refugees is well-known, the effect of adverse experiences and circumstances in the post-migration context have been less investigated, although a shift has been seen in recent years. The overall aim of this thesis was to increase the knowledge on post-migration stress and its associations with mental ill health among refugees. The thesis is based around a cross-sectional and population-based survey among refugees from Syria who were granted permanent residence permit in Sweden between 2011-2013. The objective of Study I was to estimate the prevalence of mental ill health and its associations to potential traumas and post-migration stress among refugees from Syria recently resettled in Sweden. A postal questionnaire was sent to a random sample of 4 000 individuals aged 18-64 years drawn from a sample frame containing all eligible participants. Access to registered-based information enabled the construction of non-response weights. Weighted analyses were conducted to calculate prevalence rates and associations, and associations were investigated through a series of logistic regression analyses. Results indicate that prevalence rates for anxiety, depression, PTSD, and low SWB are highly elevated among refugees from Syria with a majority meeting criteria for at least one of the included measures of mental ill health. Furthermore, experiences of potentially traumatic events (PTEs) before and during the migration as well as experiences of post-migration stress were common. Most types of PTEs and post-migration stress were associated with increased risk for mental ill health. The objective of Study II was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), an instrument for assessing refugee-related post-migration stress. The development was conducted in two phases. In the first phase, a preliminary instrument was developed based on a theoretical model of post-migration stress, covering seven hypothesized domains: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts. In the second phase, the factorial structure of the instrument was investigated in the context of the survey described in Study I, using Confirmatory and Exploratory Factor Analyses. The analyses resulted in a 7-factor model of post-migration stress that showed excellent fit to data. The final version of the RPMS contains 21 items for assessing refugee-related post-migration stress across seven domains. Experiences of post-migration stress are common among refugees from Syria recently resettled in Sweden, and as the results in this thesis show, post-migration stress is associated with increased risk for mental ill health. In order to facilitate recovery from traumatic experiences, measures should be taken on a societal level to mitigate the adverse effects of post-migration stress among refugees.
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| 9. |
- Malm, Andreas, et al.
(författare)
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The refugee post-migration stress scale (RPMS) - development and validation among refugees from Syria recently resettled in Sweden
- 2020
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Ingår i: Conflict and Health. - : BioMed Central (BMC). - 1752-1505. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the growing recognition of the impact of post-resettlement factors on the mental health of refugees, a clear definition of the concept of post-migration stress, as well as an updated, valid instrument for assessing the construct, are still lacking. The aim of the current study was to develop and validate the Refugee Post-Migration Stress Scale (RPMS), a concise, multi-dimensional instrument for assessing post-migration stress among refugees.Results: Based on a review of previous research and observations from a refugee trauma clinic, a preliminary 24-item instrument was developed, covering seven hypothesized domains of post-migration stress: perceived discrimination, lack of host country specific competences, material and economic strain, loss of home country, family and home country concerns, social strain, and family conflicts.In the context of a population-based survey of mental health among refugees from Syria recently resettled in Sweden (n = 1215), the factorial structure of the RPMS was investigated. Confirmatory Factor Analysis revealed slightly insufficient fit for the initial theorized multi-domain model. Exploratory Factor Analysis in four iterations resulted in the omission of three items and an adequate fit of a 7-factor model, corresponding to the seven hypothesized domains of post-migration stress. To assess concurrent validity, correlational analyses with measures of anxiety, depression, post-traumatic stress disorder (PTSD), and mental wellbeing were carried out. All domains of post-migration stress showed significant correlations with anxiety, depression, and PTSD scores, and significant negative correlations with mental wellbeing scores.Conclusions: The newly developed RPMS appears to be a valid instrument for assessing refugee post-migration stress. Our findings that post-migration stress primarily relating to social and economic factors seems to be associated with mental ill health among refugees is in line with previous research.
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| 10. |
- McAdams, Tom A, et al.
(författare)
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Accounting for genetic and environmental confounds in associations between parent and child characteristics : a systematic review of children-of-twins studies
- 2014
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Ingår i: Psychological Bulletin. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 0033-2909 .- 1939-1455.
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Tidskriftsartikel (refereegranskat)abstract
- Parental psychopathology, parenting style, and the quality of intrafamilial relationships are all associated with child mental health outcomes. However, most research can say little about the causal pathways underlying these associations. This is because most studies are not genetically informative and are therefore not able to account for the possibility that associations are confounded by gene-environment correlation. That is, biological parents not only provide a rearing environment for their child, but also contribute 50% of their genes. Any associations between parental phenotype and child phenotype are therefore potentially confounded. One technique for disentangling genetic from environmental effects is the children-of-twins (COT) method. This involves using data sets comprising twin parents and their children to distinguish genetic from environmental associations between parent and child phenotypes. The COT technique has grown in popularity in the last decade, and we predict that this surge in popularity will continue. In the present article we explain the COT method for those unfamiliar with its use. We present the logic underlying this approach, discuss strengths and weaknesses, and highlight important methodological considerations for researchers interested in the COT method. We also cover variations on basic COT approaches, including the extended-COT method, capable of distinguishing forms of gene-environment correlation. We then present a systematic review of all the behavioral COT studies published to date. These studies cover such diverse phenotypes as psychosis, substance abuse, internalizing, externalizing, parenting, and marital difficulties. In reviewing this literature, we highlight past applications, identify emergent patterns, and suggest avenues for future research.
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