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  • 1. Abel-Ollo, K.
    et al.
    Rahu, M.
    Rajaleid, K.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Talu, A.
    Ruutel, K.
    Platt, L.
    Bobrova, N.
    Rhodes, T.
    Uuskula, A.
    Knowledge of HIV serostatus and risk behaviour among injecting drug users in Estonia2009In: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, Vol. 21, no 7, p. 851-857Article in journal (Refereed)
    Abstract [en]

    We used the findings from two, cross-sectional studies of HIV serostatus and risk behaviours to assess the effects of knowledge of HIV serostatus and risk behaviours (relating to sex and injection drug use) among injecting drug users (IDUs). Respondent-driven sampling was used simultaneously at two sites in Estonia (the capital Tallinn, and the second-largest city of Ida-Virumaa County, Kohtla-Järve). The research tool was an interviewer-administered survey. Biological samples were collected for HIV testing. Participants were categorised into three groups based on HIV testing results and self-report on HIV serostatus: HIV-negative (n=133); HIV-positive unaware of their serostatus (n=75); and HIV-positive aware of their serostatus (n=168). In total, 65% of the participants tested positive for HIV. Of those 69% were aware of their positive serostatus. HIV-positive IDUs aware of their serostatus exhibited more risk behaviours than their HIV-positive counterparts unaware of their serostatus or HIV-negative IDUs. Effective prevention of HIV among IDUs should therefore, include programmes to reduce high-risk sexual and drug use behaviours at the public health scale and enhanced prevention efforts focusing on HIV-infected individuals.

  • 2.
    Albrecht, Sophie C.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    The longitudinal relationship between control over working hours and depressive symptoms: Results from SLOSH, a population-based cohort study2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 215, p. 143-151Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychosocial work factors can affect depressive moods, but research is inconclusive if flexibility to self-determine working hours (work-time control, WTC) is associated with depressive symptoms over time. We investigated if either sub-dimension of WTC, control over daily hours and control over time off, was related to depressive symptoms over time and examined causal, reversed-causal, and reciprocal pathways.

    METHODS: The study was based on four waves of the Swedish Longitudinal Occupational Survey of Health which is a follow-up of representative samples of the Swedish working population. WTC was measured using a 5-item index. Depressive symptoms were assessed with a brief subscale of the Symptom Checklist. Latent growth curve models and cross-lagged panel models were tested.

    RESULTS: Best fit was found for a model with correlated intercepts (control over daily hours) and both correlated intercepts and slopes (control over time off) between WTC and depressive symptoms, with stronger associations for control over time off. Causal models estimating impacts from WTC to subsequent depressive symptoms were best fitting, with a standardised coefficient between -0.023 and -0.048.

    LIMITATIONS: Results were mainly based on self-report data and mean age in the study sample was relatively high.

    CONCLUSION: Higher WTC was related to fewer depressive symptoms over time albeit small effects. Giving workers control over working hours - especially over taking breaks and vacation - may improve working conditions and buffer against developing depression, potentially by enabling workers to recover more easily and promoting work-life balance.

  • 3.
    Almquist, Ylva B
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Landstedt, E.
    Jackisch, Josephine
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hammarström, A.
    Growing through asphalt: What counteracts the long-term negative health impact of youth adversity?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl. 3Article in journal (Refereed)
    Abstract [en]

    Background

    Adversity in the family of origin tends to translate into poor health development. Yet, the fact that this is not the always the case has been seen an indicator of resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status.

    Methods

    The study was based on the Northern Swedish Cohort born in 1965 (n = 1,001). Measures of social and material adversity, health, and protective factors related to school, peers, and spare time, were derived from questionnaires distributed to the cohort members and their teachers at age 16. Self-rated health was measured at age 43. The main associations were examined by means of ordinal regression analysis, with the role of the protective factors being assessed through interaction analysis.

    Results

    Social and material adversity in youth was associated with poorer self-rated health in midlife among males and females alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time – particularly in terms of being seen as having good educational and work prospects, as well as a high-quality spare time – appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health.

    Conclusions

    There are several factors outside the context of the family that seemingly have the potential to buffer against the negative health consequences stemming from having experienced a disadvantaged upbringing. Initiatives targeted at increasing academic motivation and commitment as well as social capital and relationships in youth, may here be of particular relevance.

    Key messages:

    • While the experience of disadvantageous living conditions in adolescence tends to translate into poor health development across the life course, this is not always the case.

    • Advantages related to school, peers, and spare time have the potential of counteracting the negative health impact of an adverse family context.

  • 4.
    Almquist, Ylva B.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Landstedt, Evelina
    Jackisch, Josephine
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Prevailing over Adversity: Factors Counteracting the Long-Term Negative Health Influences of Social and Material Disadvantages in Youth2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 9, article id 1842Article in journal (Refereed)
    Abstract [en]

    Disadvantaged circumstances in youth tend to translate into poor health development. However, the fact that this is not always the case has been seen as indicative of differential resilience. The current study highlights factors outside the context of the family with the potential to counteract the long-term negative influences of social and material adversity in adolescence on general health status. This study was based on two waves of questionnaire data from the Northern Swedish Cohort. From the wave in 1981 (age 16), indicators of social and material conditions as well as factors related to school, peers, and spare time were derived. From the wave in 2008 (age 43), information about self-rated health was used. Ordinal logistic regression models (n = 908) showed that adversity in youth was associated with poorer self-rated health in midlife among men and women alike, net of health status at baseline. However, having an advantaged situation with regard to school, peers, or spare time appeared to protect against the detrimental influences of disadvantaged circumstances in the family context on subsequent health. This suggests that health-promoting interventions may benefit from focusing on contexts outside the family in their effort to strengthen processes of resilience among disadvantaged youths.

  • 5. Hallqvist, Johan
    et al.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Socialepidemiologiska metoder2012In: Den orättvisa hälsan: Om socioekonomiska skillnader i hälsa och livslängd / [ed] Rostila, M.; Toivanen, S., Liber, 2012Chapter in book (Other academic)
  • 6. Leino-Arjas, Päivi
    et al.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Mekuria, Gashaw
    Nummi, Tapio
    Virtanen, Pekka
    Hammarström, Anne
    Trajectories of musculoskeletal pain from adolescence to middle age: the role of early depressive symptoms, a 27-year follow-up of the Northern Swedish Cohort2018In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 159, no 1, p. 67-74Article in journal (Refereed)
    Abstract [en]

    Depression and musculoskeletal pain are associated, but long-term follow-up studies are rare. We aimed to examine the relationship of early depressive symptoms with developmental patterns of musculoskeletal pain from adolescence to middle age. Adolescents ending compulsory school (age 16) in Luleå, Northern Sweden, in 1981 (n = 1083) were studied and followed up in 1986, 1995, and 2008 (age 43) for musculoskeletal pain. Attrition was very low. Indicators for any and severe pain were based on pain in the neck-shoulders, low back, and the extremities. Latent class growth analyses were performed on 563 men and 503 women. Associations of a depressive symptoms score (DSS, range 0.0-2.0) at age 16 with pain trajectory membership were assessed by logistic and multinomial regression, adjusting for parental socioeconomic status, social adversities, smoking, exercise, body mass index, and alcohol consumption at age 16. For any pain, 3 trajectories emerged: high-stable (women 71%, men 61%), moderate (11%, 17%), and low-increasing (18%, 22%). With the low-increasing trajectory as reference, for each 0.1-point increase in the DSS, the odds ratio of belonging to the high-stable trajectory was 1.25 (95% confidence interval 1.11-1.41) in women and 1.23 (1.10-1.37) in men. For severe pain, 2 trajectories were found: moderate-increasing (women 19%, men 9%) and low-stable. For each 0.1-point increase in the DSS, the odds ratio of membership in the moderate-increasing trajectory was 1.14 (1.04-1.25) in women and 1.17 (1.04-1.31) in men in the fully adjusted model. Thus, depressive symptoms at baseline are strongly associated with pain trajectory membership.

  • 7. Lowe, Adrian J.
    et al.
    Ekeus, Cecilia
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Bråbäck, Lennart
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Forsberg, Bertil
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). National Board of Health and Welfare, Sweden; Karolinska Institutet, Sweden.
    Impact of Maternal Obesity on Inhaled Corticosteroid Use in Childhood: A Registry Based Analysis of First Born Children and a Sibling Pair Analysis2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 6, article id e67368Article in journal (Refereed)
    Abstract [en]

    Background

    It has been proposed that maternal obesity during pregnancy may increase the risk that the child develops allergic disease and asthma, although the mechanisms underpinning this relationship are currently unclear. We sought to assess if this association may be due to confounding by genetic or environmental risk factors that are common to maternal obesity and childhood asthma, using a sibling pair analysis.

    Methods

    The study population comprised a Swedish national cohort of term children born between 1992 and 2008 to native Swedish parents. Maternal body mass index (BMI) was measured at 8-10 weeks gestation. Unconditional logistic regression models were used to determine if maternal obesity was associated with increased risk of inhaled corticosteroid (ICS) in 431,718 first-born children, while adjusting for potential confounders. An age-matched discordant sib-pair analysis was performed, taking into account shared genetic and environmental risk factors.

    Results

    Maternal over-weight and obesity were associated with increased risk that the child would require ICS (for BMI >= 35 kg/m(2), aOR = 1.30, 95% CI = 1.10-1.52 compared with normal weight mothers) in children aged 6-12 years. Similar effects were seen in younger children, but in children aged 13-16 years, maternal obesity (BMI >= 30) was related to increased risk of ICS use in girls (aOR = 1.28, 95% CI = 1.07-1.53) but not boys (OR = 1.05, 95% CI = 0.87-1.26). The sib-pair analysis, which included 2,034 sib-pairs older than six years who were discordant for both ICS use and maternal BMI category, failed to find any evidence that increasing maternal weight was related to increased risk of ICS use.

    Conclusion

    Maternal obesity is associated with increased risk of childhood ICS use up to approximately 12 years of age, but only in girls after this age. These effects could not be confirmed in a sib pair analysis, suggesting either limited statistical power, or the effects of maternal BMI may be due to shared genetic or environmental risk factors.

  • 8.
    Rajaleid, K.
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Manor, O.
    Koupil, I.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Does the strength of the association between foetal growth rate and ischaemic heart disease mortality differ by social circumstances in early or later life?2008In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 62, no 5, p. e6-Article in journal (Refereed)
    Abstract [en]

    Objective: To study whether the effect of size at birth on the risk of ischaemic heart disease (IHD) death is modified by social circumstances in childhood or in adulthood.

    Design: A cohort study. Data on circumstances at birth were retrieved from archived obstetric records, social characteristics in adulthood and mortality follow-up through routine registers.

    Participants: 6159 men and 5663 women who were born in Uppsala University Hospital, Sweden (the Uppsala Birth Cohort) during 1915–1929, were singleton births with more than 30 weeks of gestational age and were alive in 1961. Follow-up time 1961–2002 (from age 31–46 to 73–88 years).

    Main outcome measure: Death from IHD. Multivariate Cox regression with age as the time scale, controlling for year of birth and stratified by gender.

    Results: The risk of IHD death was lower among men and women with higher weight for gestational age. Lower social class in adulthood was associated with a higher risk of IHD death. The effect of size at birth on IHD mortality did not appear to be modified by social class at birth but was only present in men of higher social class in adulthood (hazard ratio per 1 SD weight for gestational age 0.84, 95% CI 0.75 to 0.93).

    Conclusions: Weight for gestational age was inversely associated with the risk of IHD death in men and women; this effect was present in men of non-manual adult social class only but did not appear to be modified by adult social class in women or by social class at birth in either men or women.

  • 9.
    Rajaleid, Kristiina
    Institutionen för folkhälsovetenskap, Karolinska institutet.
    Early and later life mechanisms in the aetiology of cardiovascular disease2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Evidence over the recent decades indicates that susceptibility to cardiovascular disease (CVD) may be established already prenatally and in early childhood, and that the aetiological processes of the disease involve biological and social influences occurring throughout a person’s life span. Numerous studies have shown that small size at birth is associated with increased risk of CVD later in life. This finding is suggested to reflect the influence of poor foetal nutrition on the body’s organ structure, physiology and metabolism. Surprisingly, there is little empirical evidence available to support the proposed causal mechanisms. The aim of this thesis is to study the mechanisms under­lying the inverse association of size at birth with CVD.

    Three studies in the thesis are based on Uppsala Birth Cohort Study (UBCoS), a prospective cohort study which includes men and women, who were born at the Uppsala Academic Hospital between 1915 and 1929. Information from birth records, school catalogues, Hospital Discharge Register, Cause of Death Register and Censuses is used. One study is based on Stockholm Heart Epidemiology Program (SHEEP), a population based case-control study of risk factors for acute myocardial infarction (AMI) with study base including all Swedish citizens aged 45-70 years with no prior clinically diagnosed AMI, who lived in Stockholm County during 1992-1994. Data from birth records, questionnaire, health examination and blood sampling is used.

    In both data materials small size at birth was associated with increased risk of disease. Further analyses showed that birth weight for gestational age in men was associated with ischemic heart disease (IHD) mortality within the non-manual class but not among the manual workers, even if the overall mortality rate was higher in the latter. There was no difference in the association by the men’s family’s social class at birth. For women, social class neither at birth nor in adulthood modified the association between birth weight for gestational age and IHD mortality.

    We found that there was a synergistic interaction between low weight for gestational age and overweight in adulthood on risk of AMI.

    The simultaneous analysis of foetal growth, cognitive ability and IHD mortality suggested that there is an indirect association between foetal growth and cognitive ability through childhood cognitive ability.

    Finally, men with very low and very high birth weight for gestational age had a higher risk of dying after an AMI than men with intermediate birth size. Case fatality in women was not associated with their size at birth.

    The results suggest that the effect of poor foetal nutrition on CVD may be modified by social exposures later in life. The synergistic interaction between small size at birth and high adult body mass index with respect to AMI risk supports the thrifty phenotype hypothesis according to which a mismatch between foetal and adult nutrition is causing the disease. The existence of an indirect association between foetal growth and IHD mortality through childhood cognitive ability implies that mechanisms related to brain development are contributing to the association between poor foetal nutrition and IHD, in addition to the effects on physiology and metabolism. As the association of size at birth with case fatality was different from the associations with incidence and mortality, the mechanisms that operate after the AMI event and determine the prognosis might partly be different from the mechanisms that drive the development of the disease.

  • 10.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Varased ja hilisemad mehhanismid südame-veresoonkonnahaiguste etioloogias: Doktoritöö kokkuvõte2010In: Eesti PäevalehtArticle in journal (Other (popular science, discussion, etc.))
  • 11.
    Rajaleid, Kristiina
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hallqvist, Johan
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The effect of early life factors on 28 day case fatality after acute myocardial infarction2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 7, p. 720-727Article in journal (Refereed)
    Abstract [en]

    Aims: To study the association of size at birth and social circumstances at birth with 28 day case fatality of acute myocardial infarction (AMI). Methods: Based on 1,776 first cases of AMI occurring in Uppsala Birth Cohort (men and women born 1915—1929) between 1964 and 2002. Data on circumstances at birth retrieved from archived obstetric records; data on social characteristics in adulthood, hospitalizations, and date of death obtained through linkage to Censuses, Hospital Discharge Register, and Cause of Death Register. Results: We found a U-shaped association between standardized birth weight and case fatality of AMI in men (p = 0.045 for age and period adjusted quadratic trend over quintiles of standardized birth weight) that was driven by cases of AMI occurring during the early years of follow-up. We found no association between standardized birth weight and case fatality of AMI in women. There was a statistically non-significant inverse association of AMI case fatality with social class at birth as well as with social class and household income in adulthood in the cohort. Marital status was a strong determinant of case fatality in men. Conclusions: Standardized birth weight for gestational age was associated with case fatality of AMI in men. Social class at birth was weakly inversely associated with case fatality of AMI in the cohort.

  • 12.
    Rajaleid, Kristiina
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hallqvist, Johan
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Vågerö, Denny
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The role of cognitive ability in the association between size at birth and ischemic heart disease mortality2010Manuscript (preprint) (Other academic)
  • 13.
    Rajaleid, Kristiina
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Janlert, U.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Birth size is not associated with depressive symptoms from adolescence to middle-age: results from the Northern Swedish Cohort study2018In: Journal of Developmental Origins of Health and Disease, ISSN 2040-1744, E-ISSN 2040-1752Article in journal (Refereed)
    Abstract [en]

    Low birth weight has been shown to be related to increased risk of depression later in life - but the evidence is not conclusive. We examined the association of size at birth with repeatedly measured depressive symptoms in 947 individuals from the Northern Swedish Cohort, a community-based age-homogeneous cohort born in 1965, and followed with questionnaires between ages 16 and 43 (participation rate above 90% in all the surveys). Information on birth size was retrieved from archived birth records. Length of gestation was known for a subsample of 512 individuals (54%). We studied the association of birth weight and ponderal index with self-reported depressive symptoms at ages 16, 21, 30 and 43; with the life-course average of depressive symptoms score and with longitudinal trajectories of depressive symptoms retrieved by latent class growth analysis. Socioeconomic background, mental illness or alcohol problems of a parent, exposure to social adversities in adolescence and prematurity were accounted for in the analyses. We did not find any relationship between weight or ponderal index at birth and our measure of depressive symptoms between ages 16 and 43 in a series of different analyses. Adjustment for length of gestation did not alter the results. We conclude that size at birth is not associated with later-life depressive symptoms score in this cohort born in the mid-1960s in Sweden. The time and context need to be taken into consideration in future studies.

  • 14.
    Rajaleid, Kristiina
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Janszky, Imre
    Hallqvist, Johan
    Small Birth Size, Adult Overweight, and Risk of Acute Myocardial Infraction2011In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 22, no 2, p. 138-147Article in journal (Refereed)
    Abstract [en]

    Background: The association between small size at birth and increased risk of cardiovascular disease in adulthood is well established. This relationship is commonly interpreted according to the “thrifty phenotype hypothesis,” which states that the association is generated by a mismatch between fetal and postnatal nutrition. Empirical support for an interaction between impaired fetal growth and later overnutrition is, however, sparse and partly conflicting.

    Methods: The Stockholm Heart Epidemiology Program is a population-based case-control study of risk factors for acute myocardial infarction (MI); data were available for 1058 cases and 1478 controls. Using logistic regression, we studied the effect of size at birth, and its interactive effect with body mass index (BMI), at 3 occasions in adulthood, on the risk of MI. Biologic interaction was estimated with the synergy index.

    Results: Very low birth weight for gestational age was associated with increased risk of MI (odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.4–2.9; attributable fraction = 5%). In nonfatal cases, adjustment for waist-hip ratio, insulin resistance, blood pressure, and lipids reduced the point estimate somewhat. Low birth weight for gestational age in combination with high BMI at the time of the MI produced an OR of 10.8 (3.6–31.8) for MI compared with normal birth weight and normal BMI; the synergy index was 6.5 (95% CI = 1.8–24.0).

    Conclusions: The synergism between small size at birth and high adult BMI supports the thrifty phenotype hypothesis. However, this mechanism seems to pertain to only a small fraction of the acute MI cases, implying minor public health importance.

  • 15.
    Rajaleid, Kristiina
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Janszky, Imre
    Hallqvist, Johan
    Synergistic interaction between small size for gestational age and overweight in adulthood on acute myocardial infarction risk – the SHEEP study2010In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487Article in journal (Refereed)
  • 16.
    Rajaleid, Kristiina
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nummi, Tapio
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Virtanen, Pekka
    Gustafsson, Per E.
    Hammarström, Anne
    Social adversities in adolescence predict unfavourable trajectories of internalized mental health symptoms until middle age: results from the Northern Swedish Cohort2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 1, p. 23-29Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experiencing adversities during upbringing has short-term and long-term effects on mental health. This study aims to explore how social adversities in adolescence predict trajectories of internalized mental health symptoms (IMHS), from adolescence and onward until middle age.

    METHODS: Based on 1040 individuals from the Northern Swedish Cohort Study, a community-based cohort with 27 years of follow-up. We applied latent class growth analysis to extract trajectories of IMHS between ages 16 and 43. Multinomial logistic regression was used to study the association of social adversities (residential mobility, residential crowding, parental loss, unemployment of a parent, physical illness of a parent, mental illness or alcohol problems of a parent) in adolescence with IMHS trajectories.

    RESULTS: Five trajectory classes were identified: 'very low stable' (26% of the sample), 'low stable' (58%), 'moderate stable' (5%), 'increasing' (8%) and 'high decreasing' (3%). Both in men and women, reporting social adversities at the age of 16 increased the risk of belonging to the classes with less favourable development of IMHS. Reporting adversities was positively associated with the initial level of the IMHS trajectories. Thus it seems that the influence of adversities is more pronounced during the early years of follow-up and is attenuated over time.

    CONCLUSION: Experiencing social adversities in adolescence increases the risk of entering unfavourable developmental trajectories of mental health until middle age.

  • 17.
    Schiller, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hellgren, Carina
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Barck-Holst, Peter
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands.
    The impact of reduced worktime on sleep and perceived stress – a group randomized intervention study using diary data2017In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 43, no 2, p. 109-116Article in journal (Refereed)
    Abstract [en]

    Objective Insufficient time for recovery between workdays may cause fatigue and disturbed sleep. This study evaluated the impact of an intervention that reduced weekly working hours by 25% on sleep, sleepiness and perceived stress for employees within the public sector.

    Method Participating workplaces (N=33) were randomized into intervention and control groups. Participants (N=580, 76% women) worked full-time at baseline. The intervention group (N=354) reduced worktime to 75% with preserved salary during 18 months. Data were collected at baseline and after 9 and 18 months follow-up. Sleep quality, sleep duration, sleepiness, perceived stress,and worries and stress at bedtime were measured with diary during one week per data collection.

    Result A multilevel mixed model showed that compared with the control group, at the 18-month follow-up, the intervention group had improved sleep quality and sleep duration (+23 minutes) and displayed reduced levels of sleepiness, perceived stress, and worries and stress at bedtime on workdays (P<0.002). The same effects were shown for days off (P<0.006), except for sleep length. Effect sizes were small (Cohen’s f2<0.08). Adding gender, age, having children living at home, and baseline values of sleep quality and worries and stress at bedtime as additional between-group factors did not influence the results.

    Conclusion A 25% reduction of weekly work hours with retained salary resulted in beneficial effects on sleep, sleepiness and perceived stress both on workdays and days off. These effects were maintained over an 18-month period. This randomized intervention thus indicates that reduced worktime may improve recovery and perceived stress.

  • 18.
    Schiller, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hellgren, Carina
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Barck-Holst, Peter
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands.
    Total workload and recovery in relation to worktime reduction – a randomized controlled intervention study with time-use dataManuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: A 25% reduction of weekly work hours for full-time employees has been shown to improve sleep and alertness and reduce stress during both workdays and days off. The aim of the present study was to investigate how employees use their time during such an intervention: does total workload (paid and non-paid work) decrease, and recovery time increase, when work hours are reduced?

    Methods: Full-time employees within the public sector (N=636; 75% women) were randomized into intervention group and control group. The intervention group (N=370) reduced worktime to 75% with preserved salary during 18 months. Data were collected at baseline, after 9 months and 18 months. Time-use was reported every half hour daily between 06 and 01 a.m. during one week at each data collection. Data were analyzed with multilevel mixed modeling.

    Results: Compared to the control group, the intervention group increased the time spent on domestic work and relaxing hobby activities during workdays when worktime was reduced (p≤0.001). On days off, more time was spent in free-time activities (p=0.003). Total workload decreased (-65 minutes) and time spent in recovery activities increased on workdays (+53 minutes). The pattern of findings was similar in subgroups defined by gender, family status and job situation.

    Conclusions: A worktime reduction of 25% for full-time workers resulted in decreased total workload and an increase of time spent in recovery activities, which is in line with the suggestion that worktime reduction may be beneficial for long-term health and stress.

  • 19.
    Schiller, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hellgren, Carina
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Barck-Holst, Peter
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands .
    Total workload and recovery in relation to worktime reduction: a randomised controlled intervention study with time-use data2018In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 75, no 3, p. 218-226Article in journal (Refereed)
    Abstract [en]

    Objectives A 25% reduction of weekly work hours for full-time employees has been shown to improve sleep and alertness and reduce stress during both workdays and days off. The aim of the present study was to investigate how employees use their time during such an intervention: does total workload (paid and non-paid work) decrease, and recovery time increase, when work hours are reduced?

    Methods Full-time employees within the public sector (n=636; 75% women) were randomised into intervention group and control group. The intervention group (n=370) reduced worktime to 75% with preserved salary during 18 months. Data were collected at baseline, after 9 months and 18 months. Time-use was reported every half-hour daily between 06:00 and 01:00 during 1 week at each data collection. Data were analysed with multilevel mixed modelling.

    Results Compared with the control group, the intervention group increased the time spent on domestic work and relaxing hobby activities during workdays when worktime was reduced (P≤0.001). On days off, more time was spent in free-time activities (P=0.003). Total workload decreased (-65 min) and time spent in recovery activities increased on workdays (+53 min). The pattern of findings was similar in subgroups defined by gender, family status and job situation.

    Conclusions A worktime reduction of 25% for full-time workers resulted in decreased total workload and an increase of time spent in recovery activities, which is in line with the suggestion that worktime reduction may be beneficial for long-term health and stress.

  • 20.
    Schiller, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Söderström, Marie
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands.
    A randomized controlled intervention of workplace-based group cognitive behavioral therapy for insomniaManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: Sleep disturbance is common in the working population, often associated with work stress, health complaints and impaired work performance. This study evaluated a group intervention at work, based on Cognitive Behavioral Therapy (CBT) for insomnia, and the moderating effects of burnout scores at baseline.

    Methods: This is a randomized controlled intervention with a waiting-list control group. Participants were employees working at least 75% of full time, reporting self-perceived regular sleep problems. Data were collected at baseline, post-intervention and at a three-month follow-up through diaries, wrist-actigraphy and questionnaires including the Insomnia Severity Index (ISI) and the Shirom-Melamed Burnout Questionnaire (SMBQ). Fifty-one participants (63% women) completed data collections.

    Results: A multilevel mixed model showed no significant differences between groups for sleep over time, while there was a significant effect on insomnia symptoms when excluding participants working shifts (N=11) from the analysis (p=0.044). Moreover, a moderating effect of baseline-levels of burnout scores was observed on insomnia symptoms (p=0.009). A post-hoc analysis showed that individuals in the intervention group with low burnout scores at baseline (SMBQ<3.75) displayed significantly reduced ISI scores at follow-up, compared to individuals with high burnout scores at baseline (p=0.005).

    Conclusions: Group CBT for insomnia given at the workplace did not reduce sleep problems looking at the group as a whole, while it was indicated that the intervention reduced insomnia in employees with regular daytime work. The results also suggest that workplace-based group CBT may improve sleep in employees with primary insomnia if not concomitant with high burnout scores. 

  • 21.
    Schiller, Helena
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Söderström, Marie
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. KBT-Centralen, Sweden.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands.
    A randomized controlled intervention of workplace-based group cognitive behavioral therapy for insomnia2018In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 91, no 4, p. 413-424Article in journal (Refereed)
    Abstract [en]

    Sleep disturbance is common in the working population, often associated with work stress, health complaints and impaired work performance. This study evaluated a group intervention at work, based on cognitive behavioral therapy (CBT) for insomnia, and the moderating effects of burnout scores at baseline. This is a randomized controlled intervention with a waiting list control group. Participants were employees working at least 75% of full time, reporting self-perceived regular sleep problems. Data were collected at baseline, post-intervention and at a 3-month follow-up through diaries, wrist-actigraphy and questionnaires including the Insomnia Severity Index (ISI) and the Shirom-Melamed Burnout Questionnaire (SMBQ). Fifty-one participants (63% women) completed data collections. A multilevel mixed model showed no significant differences between groups for sleep over time, while there was a significant effect on insomnia symptoms when excluding participants working shifts (N = 11) from the analysis (p = 0.044). Moreover, a moderating effect of baseline-levels of burnout scores was observed on insomnia symptoms (p = 0.009). A post-hoc analysis showed that individuals in the intervention group with low burnout scores at baseline (SMBQ < 3.75) displayed significantly reduced ISI scores at follow-up, compared to individuals with high burnout scores at baseline (p = 0.005). Group CBT for insomnia given at the workplace did not reduce sleep problems looking at the group as a whole, while it was indicated that the intervention reduced insomnia in employees with regular daytime work. The results also suggest that workplace-based group CBT may improve sleep in employees with primary insomnia if not concomitant with high burnout scores.

  • 22. Talu, A.
    et al.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Abel-Ollo, K.
    Rüütel, K.
    Rahu, M.
    Rhodes, T.
    Platt, T.
    Bobrova, N.
    Uusküla, A.
    HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: Implications for intervention2009In: International journal on drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 21, no 1, p. 56-63Article in journal (Refereed)
    Abstract [en]

    Background Following a heroin shortage, fentanyl and 3-methylfentanyl, known as “China White” and “White Persian”, have become the most widely used drugs, along with amphetamine, among injecting drug users (IDUs) in Tallinn, Estonia.

    Methods In order to assess the relationships between the injection of fentanyl and amphetamine, and levels of HIV prevalence and risk behaviour, 350 current IDUs were recruited using respondent-driven sampling for an interviewer-administered unlinked cross-sectional survey and HIV testing. IDUs were categorised into groups based on self-report of the main drug used within the last 28 days.

    Results 77% (256/331) of participants reported fentanyl and 23% (75/331) amphetamine as their main drug of injection. HIV prevalence was 27% (95% confidence interval [CI]: 18.45–35.51) and 62% (95% CI: 56.97–67.03) among amphetamine and fentanyl injectors, respectively. After adjustment, fentanyl injectors had three times the odds of being HIV positive (adjusted odds ratio [AOR] = 2.89; 95% CI: 1.55–5.39). They also had higher odds for injecting in the street with a previously used needle/syringe (AOR = 2.39; 95% CI: 1.14–5.04) and sharing a needle/syringe with somebody known to have HIV (AOR = 3.00, 95% CI: 1.33–6.79). Fentanyl injectors also had higher odds for lifetime overdose (AOR = 3.02, 95% CI: 1.65–5.54).

    Conclusion The injection of fentanyl is associated with elevated injecting risk behaviour derived from injection practice and situational risk factors, and needs urgently targeted interventions.

  • 23. Uusküla, Anneli
    et al.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Talu, Ave
    Abel-Ollo, Katri
    Des Jarlais, Don C.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    A decline in the prevalence of injecting drug users in Estonia, 2005–20092013In: International Journal of Drug Policy, ISSN 0955-3959, Vol. 24, no 4, p. 312-318Article in journal (Refereed)
    Abstract [en]

    Aims: Here we report a study aimed at estimating trends in the prevalence of injection drug use between 2005 and 2009 in Estonia. Background: Descriptions of behavioural epidemics have received little attention compared with infectious disease epidemics in Eastern Europe. Methods: The number of injection drug users (IDUs) aged 15–44 each year between 2005 and 2009 was estimated using capture–recapture methodology based on 4 data sources (2 treatment data bases: drug use and non-fatal overdose treatment; criminal justice (drug related offences) and mortality (injection drug use related deaths) data). Poisson log-linear regression models were applied to the matched data, with interactions between data sources fitted to replicate the dependencies between the data sources. Linear regression was used to estimate average change over time. Results: There were 24305, 12,292, 238, 545 records and 8100, 1655, 155, 545 individual IDUs identified in the four capture sources (police, drug treatment, overdose, and death registry, accordingly) over the period 2005–2009. The estimated prevalence of IDUs among the population aged 15–44 declined from 2.7% (1.8–7.9%) in 2005 to 2.0% (1.4–5.0%) in 2008, and 0.9% (0.7–1.7%) in 2009. Regression analysis indicated an average reduction of about 1600 injectors per year. Conclusion: While the capture–recapture method has known limitations, the results are consistent with other data from Estonia. Identifying the drivers of change in the prevalence of injection drug use warrants further research.

  • 24.
    Väfors Fritz, Marie
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hemström, Örjan
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    af Klinteberg, Britt
    Quality of Life - Towards an understanding of individuals with psychopathic tendencies2009In: Personality and Mental Health, ISSN 1932-8621, Vol. 3, no 3, p. 183-192Article in journal (Refereed)
    Abstract [en]

    The objectives are to explore: (1) the association between psychopathy and self-rated quality of life; and (2) the possible role of childhood hyperactivity on the relationships between Psychopathy Checklist (PCL) scores and self-rated domains of Quality of Life (QoL). Male subjects with a history of criminality at age 11-14 years (n = 108) and matched controls (n = 59) from a Swedish longitudinal project were studied. Self-rated QoL domains of psychological health, family relationships and work satisfaction were dichotomized and used as dependent variables in calculations of odds ratios (ORs) with dichotomized PCL scores as the independent variable, as assessed at age 38-41. The results showed that for each of the three QoL domains, the proportion of individuals that reported dissatisfaction was significantly higher in both criminals and controls characterized by psychopathic tendencies (PT) compared with the groups with no psychopathic tendencies. Furthermore, the results revealed higher strata-specific risk of dissatisfaction among the PT individuals for two of the domains: psychological health (OR = 6.58) and work satisfaction (OR = 7.98). Childhood hyperactivity individuals were overrepresented in the PT group. However, hyperactivity did not confound the association between PCL and QoL. The results are discussed in the light of possible treatment implications.

  • 25.
    Vågerö, Denny
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Does childhood trauma influence offspring’s birth characteristics?2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 1, p. 219-229Article in journal (Refereed)
    Abstract [en]

    Background: A recent epigenetic hypothesis postulates that ‘a sex-specific male-line transgenerational effect exists in humans’, which can be triggered by childhood trauma during ‘the slow growth period’ just before puberty. The evidence is based on a few rather small epidemiological studies. We examine what response childhood trauma predicts, if any, in the birth size and prematurity risk of almost 800 000 offspring. Methods: Children of parity 1, 2 or 3, born 1976-2002 in Sweden, for whom we could trace both parents and all four grandparents, constituted generation 3 (G3, n ¼ 764 569). Around 5% of their parents, G2, suffered parental (G1) death during their own childhood. The association of such trauma in G2 with G3 prematurity and birthweight was analysed, while controlling for confounders in G1 and G2. We examined whether the slow growth period was extra sensitive to parental loss. Results: Parental (G1) death during (G2) childhood predicts premature birth and lower birthweight in the offspring generation (G3). This response is dependent on G2 gender, G2 age at exposure and G3 parity, but not G3 gender. Conclusions: The results are compatible with the Pembrey-Bygren hypothesis that trauma exposure during boys’ slow growth period may trigger a transgenerational response; age at trauma exposure among girls seems less important, suggesting a different set of pathways for any transgenerational response. Finally, parental death during childhood was not important for the reproduction of social inequalities in birthweight and premature birth.

  • 26.
    Vågerö, Denny
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Transgenerational response and life history theory: a response to Peeter Hõrak2017In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 46, no 1, p. 233-234Article in journal (Refereed)
  • 27.
    Westerlund, Hugo
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Virtanen, Pekka
    Gustafsson, Per E.
    Nummi, Tapio
    Hammarström, Anne
    Parental academic involvement in adolescence as predictor of mental health trajectories over the life course: a prospective population-based cohort study2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 653Article in journal (Refereed)
    Abstract [en]

    Background: Mental health problems are rising, especially among younger people, indicating a need to identify determinants of the development of mental health over the life course. Parental involvement in their children's studies, particularly in terms of academic socialisation, has been shown to predict better mental health in adulthood, as well as other more favourable health outcomes, but no study published so far has examined its impact on trajectories of mental health. We therefore sought to elucidate the role of parental involvement at age 16 on the life course development of internalised mental health symptoms. Methods: In a population-based cohort (452 women and 488 men, 87 % of the eligible participants), we examined the association between parental involvement in their offspring's studies, measured by teacher and pupil ratings at age 16, and an index of internalised mental health symptoms at the ages of 16, 18, 21, 30, and 43. Using latent class trajectory analysis, 5 different trajectories were derived from these indices: Very low stable (least symptoms), Low stable, Increasing, Moderate stable, and High decreasing (most symptoms). Multinomial logistic regression was used to regress trajectory membership on the parental involvement variables. Results: Teacher-rated parental interest in their offspring's studies during the last year of compulsory school was associated with a lower risk of entering the Moderate stable (OR = 0.54; 95 % CI 0.30 to 0.98) and High decreasing (OR = 0.41; 0.18 to 0.91) trajectories, compared with the Low stable, also after adjustment for sex, parental social class and mental health, family unemployment and own school grades. Both these associations were present only in children with grades above the national average. Student-rated availability of assistance with homework was associated with a higher chance of entering the Very low stable trajectory in the whole sample (OR = 1.24; 1.07 to 1.43), in men (OR = 1.25; 1.05 to 1.48) and in those with above average grades (OR = 1.39; 1.13 to 1.72), and with a lower risk of entering the Moderate stable in women (OR = 0.74; 0.55 to 0.99), also after the same adjustments. Conclusions: Parental involvement in their offspring's studies may buffer against poor mental health in adolescence which may track into adulthood.

  • 28.
    Åhlin, Julia K.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Jansson-Fröjmark, Markus
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Job demands, control and social support as predictors of trajectories of depressive symptoms2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 235, p. 535-543Article in journal (Refereed)
    Abstract [en]

    Background: Job demands, job control and social support have been associated with depressive symptoms. However, it is unknown how these work characteristics are associated with different trajectories of depressive symptoms, which this study aimed to examine. Methods: We included 6679 subjects in the Swedish Longitudinal Occupational Survey of Health (SLOSH), who completed biennial questionnaires in 2006-2016. Group-based trajectory models identified groups with similar development of depressive symptoms. Multinomial logistic regression estimated associations between baseline demands, control, social support and trajectories of depressive symptoms. Results: We identified six depression trajectories with varying severity and stability across four measurements. High job demands and low social support, but not low control, were associated with higher probability of belonging to subsequent trajectories with higher symptom level compared to very low symptom level. Adjusted risk ratios ranged from 1.26, 95% CI = 1.06-1.51 (low symptom trajectory) to 2.51, 95% CI = 1.43-4.41 (persistent severe symptom trajectory). Results also indicated that onset of high demands, low control and low social support increases depressive symptoms over time. Limitations: The results were based on self-reported data and all individuals did not have complete data in all waves. Conclusions: The results indicated that especially perceptions of high job demands and low social support are associated with higher or increasing levels of depressive symptoms over time. This support the supposition that high job demands, and low social support may have long-term consequences for depressive symptoms and that interventions targeting job demands and social support may contribute to a more favourable course of depression.

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