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  • 1. Andreeva, E
    et al.
    Mihályi, P
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Speed matters2011In: DEVELOPMENT OF MACRO LEVEL INDICATORS OF RESTRUCTURING AND WORKERS’ HEALTH / [ed] M. Harvey Brenner, Elena Andreeva, Berlin: Universitätsverlag der TU Berlin , 2011, , p. 355p. 166-184Chapter in book (Other academic)
  • 2. Andreeva, Elena
    et al.
    Brenner, M. Harvey
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Goldberg, Marcel
    Risk of psychological ill health and methods of organisational downsizing: a cross-sectional survey in four European countries2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 758Article in journal (Refereed)
    Abstract [en]

    Background: The manner in which organizational downsizing is implemented can make a substantial difference as to whether the exposed workers will suffer from psychological ill health. Surprisingly, little research has directly investigated this issue. We examined the likelihood of psychological ill health associated with strategic and reactive downsizing. Methods: A cross-sectional survey included 1456 respondents from France, Sweden, Hungary and the United Kingdom: 681 employees in stable workplaces (reference group) and 775 workers from downsized companies. Reactive downsizing was exemplified by the exposures to compulsory redundancies of medium to large scale resulting in job loss or surviving a layoff while staying employed in downsized organizations. The workforce exposed to strategic downsizing was represented by surplus employees who were internally redeployed and supported through their career change process within a policy context of no compulsory redundancy. Symptoms of anxiety, depression and emotional exhaustion were assessed in telephone interviews with brief subscales from Hospital Anxiety Scale (HADS-A), Hopkins Symptom Checklist (SCL-CD6) and Maslach Burnout Inventory (MBI-GS). Data were analyzed using logistic regression. Results: We observed no increased risk of psychological ill health in the case of strategic downsizing. The number of significant associations with psychological ill health was the largest for the large-scale reactive downsizing: surviving a layoff was consistently associated with all three outcome measures; returning to work after the job loss experience was related to anxiety and depression, while persons still unemployed at interview had elevated odds of anxiety. After reactive medium-scale downsizing, unemployment at interview was the only exposure associated with anxiety and depression. Conclusions: The manner in which organizational downsizing is implemented can be important for the psychological wellbeing of workers. If downsizing is unavoidable, it should be achieved strategically. Greater attention is needed to employment and health policies supporting the workers after reactive downsizing.

  • 3. Andreeva, Elena
    et al.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Brenner, M. Harvey
    Depressive symptoms as a cause and effect of job loss in men and women: evidence in the context of organisational downsizing from the Swedish Longitudinal Occupational Survey of Health2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 1045Article in journal (Refereed)
    Abstract [en]

    Background: 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). Methods: 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. Results: 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. Conclusions: 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.

  • 4.
    Aronsson, Gunnar
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Grape, Tom
    Hammarström, Anne
    Hogstedt, Christer
    Marteinsdottir, Ina
    Skoog, Ingmar
    Träskman-Bendz, Lil
    Hall, Charlotte
    A systematic review including meta-analysis of work environment and burnout symptoms2017In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, no 1, article id 264Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies - original as well as reviews - restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms.

    METHODS: A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990-2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1-5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used.

    RESULTS: Most of the 25 studies focused emotional exhaustion, fewer cynicism and still fewer personal accomplishment. Moderately strong evidence (grade 3) was concluded for the association between job control and reduced emotional exhaustion and between low workplace support and increased emotional exhaustion. Limited evidence (grade 2) was found for the associations between workplace justice, demands, high work load, low reward, low supervisor support, low co-worker support, job insecurity and change in emotional exhaustion. Cynicism was associated with most of these work factors. Reduced personal accomplishment was only associated with low reward. There were few prospective studies with sufficient quality on adverse chemical, biological and physical factors and burnout.

    CONCLUSION: While high levels of job support and workplace justice were protective for emotional exhaustion, high demands, low job control, high work load, low reward and job insecurity increased the risk for developing exhaustion. Our approach with a wide range of work exposure factors analysed in relation to the separate dimensions of burnout expanded the knowledge of associations, evidence as well as research needs. The potential of organizational interventions is illustrated by the findings that burnout symptoms are strongly influenced by structural factors such as job demands, support and the possibility to exert control.

  • 5. Berkman, Lisa F.
    et al.
    Kawachi, Ichiro
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Working conditions and health2014In: Social epidemiology / [ed] Lisa F. Berkman, Ichiro Kawachi, and Maria Glymour, Oxford: Oxford University Press, 2014, 2, p. 153--181Chapter in book (Other academic)
  • 6.
    Bodin Danielsson, Christina
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. The Royal Institute of Technology, Sweden.
    Bodin, Lennart
    Wulff, Cornelia
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Mälardalen University, Sweden.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    The relation between office type and workplace conflict: A gender and noise perspective2015In: Journal of Environmental Psychology, ISSN 0272-4944, E-ISSN 1522-9610, Vol. 42, p. 161-171Article in journal (Refereed)
    Abstract [en]

    This exploratory study aimed to investigate the impact of the office design on workplace conflicts, with a special attention to noise in the office. A gender perspective was applied. The sample consisted of 5229 employees from the Swedish Longitudinal Occupational Survey of Health 2010 (SLOSH), working in different office types. In the multivariate analysis office type was used as the explanatory variable with adjustments for age, supervisory position and labour market sector. Analysis stratified for gender was used. Among women a significant impact of office type per se on workplace conflicts was found, but not among men. For women several office types differed significantly from the cell-office with regard to prevalence of conflicts during the past two years, but for men only the combi-office differed from the cell-office. Noise had an impact on workplace conflicts, but is not the only explanatory factor since the effect of office type remained also after adjustment for noise in multivariate analyses. Other environmental factors inherent in the office type might thus explain the occurrence of conflicts.

  • 7. Bojner Horwitz, Eva
    et al.
    Hogstedt, Christer
    Wistén, Pelle
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kulturen – en viktig insats för hållbar folkhälsa: seminarier, antologi och underlag för fortsatta insatser2015In: Kultur & folkhälsa: antologi om forskning och praktik / [ed] Eva Bojner Horwitz, Christer Hogstedt, Pelle Wistén och Töres Theorell, Stockholm: Tolvnitton förlag , 2015, p. 9-11Chapter in book (Other academic)
  • 8. Bojner Horwitz, Eva
    et al.
    Hogstedt, Christer
    Wistén, Pelle
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Varför har inte fler studier publicerats? Reflektioner om seminarieserien om kultur och folkhälsa2015In: Kultur & folkhälsa: antologi om forskning och praktik / [ed] Eva Bojner Horwitz, Christer Hogstedt, Pelle Wistén, Töres Theorell, Stockholm: Tolvnitton förlag , 2015, p. 239-246Chapter in book (Other academic)
  • 9. Bojner Horwitz, Eva
    et al.
    Lennartsson, Anna-Karin
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ullén, Fredrik
    Engagement in dance is associated with emotional competence in interplay with others2015In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 6, article id 1096Article in journal (Refereed)
    Abstract [en]

    This study has explored the relation between dance achievement and alexithymia in a larger Swedish population sample (Swedish Twin Registry) with a study sample of 5431 individuals. Dance achievement (CAQ) was assessed in relation to Alexithymia (Toronto Alexithymia Scale, TAS-20) including the three subscales: Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF), and Externally Oriented Thinking (EOT). The results show a significant negative association between the TAS subscale (EOT) and creative achievement in dance. A high EOT score corresponds to poor ability to communicate feelings to the environment. There was no consistent association between the other factors DIF and DDF and dance achievement. Dance activity and training seem to be involved in the body's emotional interplay with others. Embodied cognition, emotional perception, and action are discussed as factors relevant to measuring the skill of a dancer.

  • 10. Bojner Horwitz, Eva
    et al.
    Osika, Walter
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hållbarhetstestning och implementering av kulturaktiviteter – forskarsamhällets roll2015In: Kultur & folkhälsa: antologi om forskning och praktik / [ed] Eva Bojner Horwitz, Christer Hogstedt, Pelle Wistén, Töres Theorell, Stockholm: Tolvnitton förlag , 2015, p. 107-114Chapter in book (Other academic)
  • 11. Brenner, M. Harvey
    et al.
    Andreeva, Elena
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Goldberg, Marcel
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Imbernon, Ellen
    Bonnaud, Sophie
    Organizational downsizing and depressive symptoms in the European recession: the experience of workers in France, Hungary, Sweden and the United kingdom2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 5, article id e97063Article in journal (Refereed)
    Abstract [en]

    Background: Organizational downsizing has become highly common during the global recession of the late 2000s with severe repercussions on employment. We examine whether the severity of the downsizing process is associated with a greater likelihood of depressive symptoms among displaced workers, internally redeployed workers and lay-off survivors. Methods: A cross-sectional survey involving telephone interviews was carried out in France, Hungary, Sweden and the United Kingdom. The study analyzes data from 758 workers affected by medium-and large-scale downsizing, using multiple logistic regression. Main Results: Both unemployment and surviving layoffs were significantly associated with depressive symptoms, as compared to reemployment, but the perceived procedural justice of a socially responsible downsizing process considerably mitigated the odds of symptoms. Perception of high versus low justice was assessed along several downsizing dimensions. In the overall sample, chances to have depressive symptoms were significantly reduced if respondents perceived the process as transparent and understandable, fair and unbiased, well planned and democratic; if they trusted the employer's veracity and agreed with the necessity for downsizing. The burden of symptoms was significantly greater if the process was perceived to be chaotic. We further tested whether perceived justice differently affects the likelihood of depressive symptoms among distinct groups of workers. Findings were that the odds of symptoms largely followed the same patterns of effects across all groups of workers. Redeploying and supporting surplus employees through the career change process-rather than forcing them to become unemployed-makes a substantial difference as to whether they will suffer from depressive symptoms. Conclusions: While depressive symptoms affect both unemployed and survivors, a just and socially responsible downsizing process is important for the emotional health of workers.

  • 12. Canlon, Barbara
    et al.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute, Sweden.
    Hasson, Dan
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Associations between stress and hearing problems in humans2013In: Hearing Research, ISSN 0378-5955, E-ISSN 1878-5891, Vol. 295, no 1-2, p. 9-15Article in journal (Refereed)
    Abstract [en]

    Hearing problems are a public health issue with prevalence figures far more common than previously estimated. There are well-established risk factors of hearing problems such as age, sex and noise exposure history. Here, we demonstrate additional risk factors, i.e. socioeconomic status and long-term stress exposure that are found to increase the risk of hearing problems. In order to proactively intervene and prevent hearing problems, these newly recognized risk factors need to be taken into consideration. When taking these new risk factors into account, sex differences become even more apparent than previously found. The aim of this review is to summarize our recent findings about the associations between stress and hearing problems.

  • 13.
    Chungkham, Holendro Singh
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ingre, Michael
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Karasek, Robert
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Factor Structure and Longitudinal Measurement Invariance of the Demand Control Support Model: An Evidence from the Swedish Longitudinal Occupational Survey of Health (SLOSH)2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 8, article id e70541Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To examine the factor structure and to evaluate the longitudinal measurement invariance of the demand-control-support questionnaire (DCSQ), using the Swedish Longitudinal Occupational Survey of Health (SLOSH).

    METHODS: A confirmatory factor analysis (CFA) and multi-group confirmatory factor analysis (MGCFA) models within the framework of structural equation modeling (SEM) have been used to examine the factor structure and invariance across time.

    RESULTS: FOUR FACTORS: psychological demand, skill discretion, decision authority and social support, were confirmed by CFA at baseline, with the best fit obtained by removing the item repetitive work of skill discretion. A measurement error correlation (0.42) between work fast and work intensively for psychological demands was also detected. Acceptable composite reliability measures were obtained except for skill discretion (0.68). The invariance of the same factor structure was established, but caution in comparing mean levels of factors over time is warranted as lack of intercept invariance was evident. However, partial intercept invariance was established for work intensively.

    CONCLUSION: Our findings indicate that skill discretion and decision authority represent two distinct constructs in the retained model. However removing the item repetitive work along with either work fast or work intensively would improve model fit. Care should also be taken while making comparisons in the constructs across time. Further research should investigate invariance across occupations or socio-economic classes.

  • 14.
    Chungkham, Holendro Singh
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    A Longitudinal Analysis of Confirmatory Factor Structure and Measurement Invariance of the Demand Control Support Model: An evidence from SLOSH2013Conference paper (Refereed)
  • 15. de Manzano, Orjan
    et al.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Harmat, László
    Ullén, Fredrik
    The psychophysiology of flow during piano playing2010In: Emotion, ISSN 1528-3542, E-ISSN 1931-1516, Vol. 10, no 3, p. 301-11Article in journal (Refereed)
    Abstract [en]

    Expert performance is commonly accompanied by a subjective state of optimal experience called flow. Previous research has shown positive correlations between flow and quality of performance and suggests that flow may function as a reward signal that promotes practice. Here, piano playing was used as a flow-inducing behavior in order to analyze the relationship between subjective flow reports and psychophysiological measures. Professional classical pianists were asked to play a musical piece and then rate state flow. The performance was repeated five times in order to induce a variation in flow, keeping other factors constant, while recording the arterial pulse pressure waveform, respiration, head movements, and activity from the corrugator supercilii and zygomaticus major facial muscles. A significant relation was found between flow and heart period, blood pressure, heart rate variability, activity of the zygomaticus major muscle, and respiratory depth. These findings are discussed in relation to current models of emotion, attention, and expertise, and flow is proposed to be a state of effortless attention, which arises through an interaction between positive affect and high attention.

  • 16. Dragano, Nico
    et al.
    Siegrist, Johannes
    Nyberg, Solja T.
    Lunau, Thorsten
    Fransson, Eleonor I.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Erbel, Raimund
    Fahlén, Göran
    Goldberg, Marcel
    Hamer, Mark
    Heikkilä, Katriina
    Jöckel, Karl-Heinz
    Knutsson, Anders
    Madsen, Ida E. H.
    Nielsen, Martin L.
    Nordin, Maria
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Umeå University, Sweden.
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Schupp, Jürgen
    Singh-Manoux, Archana
    Steptoe, Andrew
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Virtanen, Marianna
    Zins, Marie
    Batty, G. David
    Kivimäki, Mika
    Effort-Reward Imbalance at Work and Incident Coronary Heart Disease A Multicohort Study of 90,164 Individuals2017In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 28, no 4, p. 619-626Article in journal (Refereed)
    Abstract [en]

    Background: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease.

    Methods: This multicohort study (the IPD-Work consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis.

    Results: At baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain.

    Conclusions: Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.

  • 17.
    Fransson, Eleonor I.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Heikkilä, Katriina
    Nyberg, Solja T.
    Zins, Marie
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. University College London, United Kingdom.
    Westerholm, Peter
    Väänänen, Ari
    Virtanen, Marianna
    Vahtera, Jussi
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Suominen, Sakari
    Singh-Manoux, Archana
    Siegrist, Johannes
    Sabia, Séverine
    Rugulies, Reiner
    Pentti, Jaana
    Oksanen, Tuula
    Nordin, Maria
    Nielsen, Martin L
    Marmot, Michael G
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Madsen, Ida E. H.
    Lunau, Thorsten
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kumari, Meena
    Kouvonen, Anne
    Koskinen, Aki
    Koskenvuo, Markku
    Knutsson, Anders
    Kittel, France
    Jöckel, Karl-Heinz
    Joensuu, Matti
    Houtman, Irene L.
    Hooftman, Wendela E.
    Goldberg, Marcel
    Geuskens, Goedele A.
    Ferrie, Jane E.
    Erbel, Raimund
    Dragano, Nico
    De Bacquer, Dirk
    Clays, Els
    Casini, Annalisa
    Burr, Hermann
    Borritz, Marianne
    Bonenfant, Sébastien
    Bjorner, Jakob B.
    Alfredsson, Lars
    Hamer, Mark
    Batty, G. David
    Kivimäki, Mika
    Job Strain as a Risk Factor for Leisure-Time Physical Inactivity: An Individual-Participant Meta-Analysis of Up to 170,000 Men and Women The IPD-Work Consortium2012In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 176, no 12, p. 1078-1089Article in journal (Refereed)
    Abstract [en]

    Unfavorable work characteristics, such as low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time, but this has not been verified in large-scale studies. The authors combined individual-level data from 14 European cohort studies (baseline years from 1985-1988 to 2006-2008) to examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50% women; mean age, 43.5 years). Of these employees, 56,735 were reexamined after 2-9 years. In cross-sectional analyses, the odds for physical inactivity were 26% higher (odds ratio = 1.26, 95% confidence interval: 1.15, 1.38) for employees with high-strain jobs (low control/high demands) and 21% higher (odds ratio = 1.21, 95% confidence interval: 1.11, 1.31) for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). In prospective analyses restricted to physically active participants, the odds of becoming physically inactive during follow-up were 21% and 20% higher for those with high-strain (odds ratio = 1.21, 95% confidence interval: 1.11, 1.32) and passive (odds ratio = 1.20, 95% confidence interval: 1.11, 1.30) jobs at baseline. These data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity.

  • 18.
    Fransson, Eleonor I.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Nyberg, Solja T.
    Heikkilä, Katriina
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Geuskens, Goedele A.
    Goldberg, Marcel
    Hamer, Mark
    Hooftman, Wendela E.
    Houtman, Irene L
    Joensuu, Matti
    Jokela, Markus
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kumari, Meena
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lunau, Thorsten
    Madsen, Ida E. H.
    Magnusson Hanson, Linda
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Pejtersen, Jan H.
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J.
    Steptoe, Andrew
    Suominen, Sakari B.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Toppinen-Tanner, Salla
    Vahtera, Jussi
    Virtanen, Marianna
    Väänänen, Ari
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Zins, Marie
    Britton, Annie
    Brunner, Eric J.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimäki, Mika
    Job strain and the risk of stroke: an individual-participant data meta-analysis2015In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 46, no 2, p. 557-559Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Psychosocial stress at work has been proposed to be a risk factor for cardiovascular disease. However, its role as a risk factor for stroke is uncertain.

    METHODS: We conducted an individual-participant-data meta-analysis of 196 380 males and females from 14 European cohort studies to investigate the association between job strain, a measure of work-related stress, and incident stroke.

    RESULTS: In 1.8 million person-years at risk (mean follow-up 9.2 years), 2023 first-time stroke events were recorded. The age- and sex-adjusted hazard ratio for job strain relative to no job strain was 1.24 (95% confidence interval, 1.05;1.47) for ischemic stroke, 1.01 (95% confidence interval, 0.75;1.36) for hemorrhagic stroke, and 1.09 (95% confidence interval, 0.94;1.26) for overall stroke. The association with ischemic stroke was robust to further adjustment for socioeconomic status.

    CONCLUSION: Job strain may be associated with an increased risk of ischemic stroke, but further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies.

  • 19. Fransson, Eleonor I.
    et al.
    Nyberg, Solja T.
    Heikkilä, Katriina
    Alfredsson, Lars
    De Bacquer, Dirk
    Batty, G. David
    Bonenfant, Sebastien
    Casini, Annalisa
    Clays, Els
    Goldberg, Marcel
    Kittel, France
    Koskenvuo, Markku
    Knutsson, Anders
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nordin, Maria
    Singh-Manoux, Archana
    Suominen, Sakari
    Vahtera, Jussi
    Westerholm, Peter
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. University College London, UK.
    Zins, Marie
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kivimäki, Mika
    Comparison of alternative versions of the job demand-control scales in 17 European cohort studies: the IPD-Work consortium2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, article id 62Article in journal (Refereed)
    Abstract [en]

    Background: Job strain (i.e., high job demands combined with low job control) is a frequently used indicator of harmful work stress, but studies have often used partial versions of the complete multi-item job demands and control scales. Understanding whether the different instruments assess the same underlying concepts has crucial implications for the interpretation of findings across studies, harmonisation of multi-cohort data for pooled analyses, and design of future studies. As part of the 'IPD-Work' (Individual-participant-data meta-analysis in working populations) consortium, we compared different versions of the demands and control scales available in 17 European cohort studies. Methods: Six of the 17 studies had information on the complete scales and 11 on partial scales. Here, we analyse individual level data from 70 751 participants of the studies which had complete scales (5 demand items, 6 job control items). Results: We found high Pearson correlation coefficients between complete scales of job demands and control relative to scales with at least three items (r > 0.90) and for partial scales with two items only (r = 0.76-0.88). In comparison with scores from the complete scales, the agreement between job strain definitions was very good when only one item was missing in either the demands or the control scale (kappa > 0.80); good for job strain assessed with three demand items and all six control items (kappa > 0.68) and moderate to good when items were missing from both scales (kappa = 0.54-0.76). The sensitivity was > 0.80 when only one item was missing from either scale, decreasing when several items were missing in one or both job strain subscales. Conclusions: Partial job demand and job control scales with at least half of the items of the complete scales, and job strain indices based on one complete and one partial scale, seemed to assess the same underlying concepts as the complete survey instruments.

  • 20. Grape Viding, Christina
    et al.
    Osika, Walter
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kowalski, Jan
    Hallqvist, Johan
    Bojner Horwitz, Eva
    "The culture palette" – a randomized intervention study for women with burnout symptoms in Sweden2015In: British Journal of Medical Practitioners, ISSN 1757-8515, Vol. 8, no 2, article id a813Article in journal (Refereed)
    Abstract [en]

    Burnout is common among women in Sweden. Cultural activities, i.e. arts, have benefitted different patient populations and may have potential for treating this group as well. Aim: To evaluate possible health effects of regular cultural activities for women with burnout symptoms with focus on exhaustion level.Methods: 48 women (mean age 54) were randomly assigned either to a cultural activity group (intervention group) or to a control group. Four health care centers were the settings for a “Culture Palette” comprised of six different cultural activity packages: interactive theater, movie, vocal improvisation and drawing, dance, mindfulness training and musical show. The activity packages were offered once a week over a period of three months. Standardized questionnaires; the Karolinska Exhaustion Disorder Scale ( KEDS), Sense of Coherence (SOC), Toronto Alexithymia Scale (TAS)  and Self-rated health  were used at baseline, in month three and at follow-up in month six. Qualitative interviews with patients, cultural producers and health care staff were conducted at month three and month six.Results: Burnout symptoms/exhaustion (P< .001) and alexithymia (P=0.007) as well as self-rated health (P<0.001) improved more in the intervention group than in the control group with clinically relevant effect variances. There was no statistical evidence of any difference in the development of SOC between the intervention and the control group. The healthcare staff were also positively affected although they did not participate in the cultural activities. Conclusion: Regular cultural activities affected this group of women beneficially with enhanced health and decreased levels of exhaustion.

  • 21. Gustafsson, Per E
    et al.
    Janlert, Urban
    Theorell, Tores
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Fetal and life course origins of serum lipids in mid-adulthood: results from a prospective cohort study2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, no 1, p. 484-Article in journal (Refereed)
    Abstract [en]

    ABSTRACT: BACKGROUND: During the past two decades, the hypothesis of fetal origins of adult disease has received considerable attention. However, critique has also been raised regarding the failure to take the explanatory role of accumulation of other exposures into consideration, despite the wealth of evidence that social circumstances during the life course impact on health in adulthood. The aim of the present prospective cohort study was to examine the contributions of birth weight and life course exposures (cumulative socioeconomic disadvantage and adversity) to dyslipidemia and serum lipids in mid-adulthood. METHODS: A cohort (effective n = 824, 77%) was prospectively examined with respect to self-reported socioeconomic status as well as stressors (e.g., financial strain, low decision latitude, separation, death or illness of a close one, unemployment) at the ages of 16, 21, 30 and 43 years; summarized in cumulative socioeconomic disadvantage and cumulative adversity. Information on birth weight was collected from birth records. Participants were assessed for serum lipids (total cholesterol, low- and high-density lipoprotein cholesterol and triglycerides), apolipoproteins (A1 and B) and height and weight (for the calculation of body mass index, BMI) at age 43. Current health behavior (alcohol consumption, smoking and snuff use) was reported at age 43. RESULTS: Cumulative life course exposures were related to several outcomes; mainly explained by cumulative socioeconomic disadvantage in the total sample (independently of current health behaviors but attenuated by current BMI) and also by cumulative adversity in women (partly explained by current health behavior but not by BMI). Birth weight was related only to triglycerides in women, independently of life course exposures, health behaviors and BMI. No significant association of either exposure was observed in men. CONCLUSIONS: Social circumstances during the life course seem to be of greater importance than birth weight for dyslipidemia and serum lipid levels in adulthood.

  • 22. Gustafsson, Per E
    et al.
    Janlert, Urban
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Is body size at birth related to circadian salivary cortisol levels in adulthood?: Results from a longitudinal cohort study2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, p. 346-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The hypothesis of fetal origins of adult disease has during the last decades received interest as an explanation of chronic, e.g. cardiovascular, disease in adulthood stemming from fetal environmental conditions. Early programming and enduring dysregulations of the hypothalamic-pituitary-adrenal (HPA axis), with cortisol as its end product, has been proposed as a possible mechanism by which birth weight influence later health status. However, the fetal origin of the adult cortisol regulation has been insufficiently studied. The present study aims to examine if body size at birth is related to circadian cortisol levels at 43 years. METHODS: Participants were drawn from a prospective cohort study (n = 752, 74.5%). Salivary cortisol samples were collected at four times during one day at 43 years, and information on birth size was collected retrospectively from delivery records. Information on body mass during adolescence and adulthood and on health behavior, medication and medical conditions at 43 years was collected prospectively by questionnaire and examined as potential confounders. Participants born preterm or < 2500 g were excluded from the main analyses. RESULTS: Across the normal spectrum, size at birth (birth weight and ponderal index) was positively related to total (area under the curve, AUC) and bedtime cortisol levels in the total sample. Results were more consistent in men than in women. Descriptively, participants born preterm or < 2500 g also seemed to display elevated evening and total cortisol levels. No associations were found for birth length or for the cortisol awakening response (CAR). CONCLUSIONS: These results are contradictory to previously reported negative associations between birth weight and adult cortisol levels, and thus tentatively question the assumption that only low birth weight predicts future physiological dysregulations.

  • 23. Gustafsson, Per E
    et al.
    Janlert, Urban
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Life-course socioeconomic trajectories and diurnal cortisol regulation in adulthood2010In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 35, no 4, p. 613-23Article in journal (Refereed)
    Abstract [en]

    Although the health risk of socioeconomic disadvantage over the life-course is fairly established, the mechanisms are less studied. One candidate pathway is long-term dysregulation of cortisol. This study assesses whether socioeconomic trajectories from adolescence to adulthood influences the regulation of cortisol in mid-adulthood, and further investigates the importance of adolescence as a critical period and of accumulation of socioeconomic disadvantage. Participants were drawn from a 27-year prospective cohort study (n=732, 68% of the original cohort). Information on socioeconomic status (SES) was collected at the ages of 16 (based on parental occupation), 21, 30 and 43 (based on own occupation) years, and at 43 years participants collected one-day salivary cortisol samples at awakening, after 15min, before lunch and at bedtime. We found that the cortisol awakening response (CAR) differed with respect to SES trajectory; those with stable low or early low/upwardly mobile SES tended to display higher CAR than those with early high/downwardly mobile, highly mobile or stable high trajectories. Further analyses revealed that early low SES was related to higher CAR, and in women low SES was related to lower bedtime cortisol, independently of later SES and potential confounders. We found no support for a linear effect of accumulation of socioeconomic disadvantage. In conclusion, our study gives support for an independent effect of low socioeconomic status early in life, on the regulation of cortisol in adulthood.

  • 24. Gustafsson, Per E.
    et al.
    Janlert, Urban
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Do Peer Relations in Adolescence Influence Health in Adulthood?: Peer Problems in the School Setting and the Metabolic Syndrome in Middle-Age2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 6, p. e39385-Article in journal (Refereed)
    Abstract [en]

    While the importance of social relations for health has been demonstrated in childhood, adolescence and adulthood, few studies have examined the prospective importance of peer relations for adult health. The aim of this study was to examine whether peer problems in the school setting in adolescence relates to the metabolic syndrome in middle-age. Participants came from the Northern Swedish Cohort, a 27-year cohort study of school leavers (effective n = 881, 82% of the original cohort). A score of peer problems was operationalized through form teachers' assessment of each student's isolation and popularity among school peers at age 16 years, and the metabolic syndrome was measured by clinical measures at age 43 according to established criteria. Additional information on health, health behaviors, achievement and social circumstances were collected from teacher interviews, school records, clinical measurements and self-administered questionnaires. Logistic regression was used as the main statistical method. Results showed a dose-response relationship between peer problems in adolescence and metabolic syndrome in middle-age, corresponding to 36% higher odds for the metabolic syndrome at age 43 for each SD higher peer problems score at age 16. The association remained significant after adjustment for health, health behaviors, school adjustment or family circumstances in adolescence, and for psychological distress, health behaviors or social circumstances in adulthood. In analyses stratified by sex, the results were significant only in women after adjustment for covariates. Peer problems were significantly related to all individual components of the metabolic syndrome. These results suggest that unsuccessful adaption to the school peer group can have enduring consequences for metabolic health.

  • 25. Gustafsson, Per E.
    et al.
    Janlert, Urban
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Social and material adversity from adolescence to adulthood and allostatic load in middle-aged women and men: results from the Northern Swedish Cohort2012In: Annals of Behavioral Medicine, ISSN 0883-6612, E-ISSN 1532-4796, Vol. 43, no 1, p. 117-28Article in journal (Refereed)
    Abstract [en]

    Background

    Little is known about the theoretically assumed association between adversity exposure over the life course and allostatic load in adulthood.

    Purpose

    This study aims to examine whether social and material adversity over the life course is related to allostatic load in mid-adulthood.

    Methods

    A 27-year prospective Swedish cohort (N = 822; 77% response rate) reported exposure to social and material adversities at age 16, 21, 30 and 43 years. At age 43, allostatic load was operationalized based on 12 biological parameters.

    Results

    Social adversity accumulated over the life course was related to allostatic load in both women and men, independently of cumulative socioeconomic disadvantage. Moreover, social adversity in adolescence (in women) and young adulthood (in men) was related to allostatic load, independently of cumulative socioeconomic disadvantage and also of later adversity exposure during adulthood.

    Conclusion

    Exposure to adversities involving relational threats impacts on allostatic load in adulthood and operates according to life course models of cumulative risk and a sensitive period around the transition into adulthood.

  • 26. Gustafsson, Per E
    et al.
    Janlert, Urban
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Socioeconomic status over the life course and allostatic load in adulthood: results from the Northern Swedish Cohort.2011In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 65, no 11, p. 986-92Article in journal (Refereed)
    Abstract [en]

    Background Although several studies have reported rather consistent associations between socioeconomic status (SES) and allostatic load (AL), so far no study has examined the influence of SES over the life course on AL. The aim of the present study was to investigate the association between SES over the life course and AL in mid-adulthood, guided by the conceptual models of cumulative risk, critical period and social chain of risk. Methods The sample comprises a 27-year prospective cohort (n=1071) from northern Sweden. Participants (n=855, 79.8%) completed questionnaires at the ages of 16, 21, 30 and 43&emsp14;years. A health examination was performed at age 43&emsp14;years after an overnight fast, including physical examination and blood sampling, and participants completed 1-day salivary cortisol sampling (four samples). SES was based on parental occupation at age 16&emsp14;years and participants' own occupation at ages 21, 30 and 43&emsp14;years. Information on daily smoking, snuff use, high alcohol consumption and physical inactivity was reported by the participants. An AL index was constructed from tertiles of 12 biological parameters. Results Cumulative socioeconomic disadvantage was related to AL in both women and men. The association was largely explained by health behaviours in men, but was independent of health behaviours in women. In women, an association was observed between AL and SES in adolescence, whereas in men only current SES was related to AL, independently of current health behaviours. Conclusions SES over the life course influences the level of multi-systemic dysregulation in mid-adulthood, with the strongest support for the cumulative risk model.

  • 27. Gustafsson, Per E
    et al.
    San Sebastian, Miguel
    Janlert, Urban
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Life-course accumulation of neighborhood disadvantage and allostatic load: empirical integration of three social determinants of health frameworks2014In: American Journal of Public Health, ISSN 0090-0036, E-ISSN 1541-0048, Vol. 104, no 5, p. 904-910Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We examined if the accumulation of neighborhood disadvantages from adolescence to mid-adulthood were related to allostatic load, a measure of cumulative biological risk, in mid-adulthood, and explored whether this association was similar in women and men.

    METHODS: Data were from the participants in the Northern Swedish Cohort (analytical n = 818) at ages 16, 21, 30, and 43 years in 1981, 1986, 1995, and 2008. Personal living conditions were self-reported at each wave. At age 43 years, 12 biological markers were measured to operationalize allostatic load. Registered data for all residents in the cohort participants' neighborhoods at each wave were used to construct a cumulative measure of neighborhood disadvantage. Associations were examined in ordinary least-squares regression models.

    RESULTS: We found that cumulative neighborhood disadvantage between ages 16 and 43 years was related to higher allostatic load at age 43 years after adjusting for personal living conditions in the total sample (B = 0.11; P = .004) and in men (B = 0.16; P = .004), but not in women (B = 0.07; P = .248).

    CONCLUSIONS: Our findings suggested that neighborhood disadvantage acted cumulatively over the life course on biological wear and tear, and exemplified the gains of integrating social determinants of health frameworks.

  • 28. Gustafsson, Per E.
    et al.
    San Sebastian, Miguel
    Janlert, Urban
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hammarström, Anne
    Residential Selection across the Life Course: Adolescent Contextual and Individual Determinants of Neighborhood Disadvantage in Mid-Adulthood2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 11, p. e80241-Article in journal (Refereed)
    Abstract [en]

    Background: Numerous cross-sectional studies have examined neighborhood effects on health. Residential selection in adulthood has been stressed as an important cause of selection bias but has received little empirical attention, particularly its determinants from the earlier life course. The present study aims to examine whether neighborhood, family, school, health behaviors and health in adolescence are related to socioeconomic disadvantage of one's neighborhood of residence in adulthood. Methods: Based on the prospective Northern Swedish Cohort (analytical N = 971, 90.6% retention rate), information was collected at age 16 years concerning family circumstances, school adjustment, health behaviors and mental and physical health. Neighborhood register data was linked to the cohort and used to operationalize aggregated measures of neighborhood disadvantage (ND) at age 16 and 42. Data was analyzed with linear mixed models, with ND in adulthood regressed on adolescent predictors and neighborhood of residence in adolescence as the level-2 unit. Results: Neighborhood disadvantage in adulthood was clustered by neighborhood of residence in adolescence (ICC = 8.6%). The clustering was completely explained by ND in adolescence. Of the adolescent predictors, ND (b =.14 (95% credible interval =.07-.22)), final school marks (b =-.18 (-.26--.10)), socioeconomic disadvantage (b =.07 (.01-.14)), and, with borderline significance, school peer problems (b =-.07 (-.00-.13)), were independently related to adulthood ND in the final adjusted model. In sex-stratified analyses, the most important predictors were school marks (b =-.21 (-.32--.09)) in women, and neighborhood of residence (ICC = 15.5%) and ND (b =.20 (.09-.31)) in men. Conclusions: These findings show that factors from adolescence - which also may impact on adult health - could influence the neighborhood context in which one will live in adulthood. This indicates that residential selection bias in neighborhood effects on health research may have its sources in early life.

  • 29. Harmat, Laszlo
    et al.
    de Manzano, Örjan
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Högman, Lennart
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ullén, Fredrik
    Physiological correlates of the flow experience during computer game playing2015In: International Journal of Psychophysiology, ISSN 0167-8760, E-ISSN 1872-7697, Vol. 97, no 1, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Flow is the subjective experience of effortless attention, reduced self-awareness, and enjoyment that typically occurs during optimal task performance. Previous studies have suggested that flow may be associated with a non-reciprocal coactivation of the sympathetic and parasympathetic systems and, on a cortical level, with a state of hypofrontality and implicit processing. Here, we test these hypotheses, using the computer game TETRIS as model task. The participants (n = 77) played TETRIS under three conditions that differed in difficulty (Easy < Optimal < Difficult). Cardiac and respiratory activities, and the average oxygenation changes of the prefrontal cortex were measured continuously with functional near infrared spectroscopy (INIRS) during performance. The Optimal condition was characterized by the highest levels of state flow, positive affect, and effortless attention. The associations between self-reported psychological flow and physiological measures were investigated using a series of repeated measures linear mixed model analyses. The results showed that higher flow was associated with larger respiratory depth and lower LF. The higher respiratory depth during high flow is indicative of a more relaxed state with an increased parasympathetic activity, and thus provides partial support for the main hypotheses. There was no association between frontal cortical oxygenation and flow, even at liberal thresholds; i.e. we found no support that flow is related to a state of hypofrontality.

  • 30.
    Hasson, Dan
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Benka Wallén, Martin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Canlon, Barbara
    Stress and prevalence of hearing problems in the Swedish working population2011In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, p. 130-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Current human and experimental studies are indicating an association between stress and hearing problems; however potential risk factors have not been established. Hearing problems are projected to become among the top ten disabilities according to the WHO in the near future. Therefore a better understanding of the relationships between stress and hearing is warranted. Here we describe the prevalence of two common hearing problems, i.e. hearing complaints and tinnitus, in relation to different work-and health-related stressors. METHODS: A total of 18,734 individuals were invited to participate in the study, out of which 9,756 (52 %) enrolled. RESULTS: The results demonstrate a clear and mostly linear relationship between higher prevalence of hearing problems (tinnitus or hearing loss or both) and different stressors, e.g. occupational, poorer self-rated health, long-term illness, poorer sleep quality, and higher burnout scores. CONCLUSIONS: The present study unambiguously demonstrates associations between hearing problems and various stressors that have not been previously described for the auditory system. These findings will open new avenues for future investigations.

  • 31.
    Hasson, Dan
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Bergquist, Jonas
    Canlon, Barbara
    Acute stress induces hyperacusis in women with high levels of emotional exhaustion2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 1, p. e52945-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hearing problems is one of the top ten public health disorders in the general population and there is a well-established relationship between stress and hearing problems. The aim of the present study was to explore if an acute stress will increase auditory sensitivity (hyperacusis) in individuals with high levels of emotional exhaustion (EE).

    METHODS: Hyperacusis was assessed using uncomfortable loudness levels (ULL) in 348 individuals (140 men; 208 women; age 23-71 years). Multivariate analyses (ordered logistic regression), were used to calculate odds ratios, including interacting or confounding effects of age, gender, ear wax and hearing loss (PTA). Two-way ANCOVAs were used to assess possible differences in mean ULLs between EE groups pre- and post-acute stress task (a combination of cold pressor, emotional Stroop and Social stress/video recording).

    RESULTS: There were no baseline differences in mean ULLs between the three EE groups (one-way ANOVA). However, after the acute stress exposure there were significant differences in ULL means between the EE-groups in women. Post-hoc analyses showed that the differences in mean ULLs were between those with high vs. low EE (range 5.5-6.5 dB). Similar results were found for frequencies 0.5 and 1 kHz. The results demonstrate that women with high EE-levels display hyperacusis after an acute stress task. The odds of having hyperacusis were 2.5 (2 kHz, right ear; left ns) and 2.2 (4 kHz, right ear; left ns) times higher among those with high EE compared to those with low levels. All these results are adjusted for age, hearing loss and ear wax.

    CONCLUSION: Women with high levels of emotional exhaustion become more sensitive to sound after an acute stress task. This novel finding highlights the importance of including emotional exhaustion in the diagnosis and treatment of hearing problems.

  • 32.
    Hasson, Dan
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Canlon, Barbara
    Prevalence and characteristics of hearing problems in a working and non-working Swedish population2010In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 64, no 5, p. 453-60Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hearing problems are among the top 10 most common burdens of disease and are projected to be become even more common by the year 2030. The aim of the present study was to give a current assessment of the prevalence of communication difficulties because of hearing loss and tinnitus, in the general Swedish working and non-working populations in relation to sex, age, socioeconomic status (SES) and noise exposure. How prevalence is affected by SES has not been previously established. METHODS: A total of 18 734 individuals were invited to participate in the study, of which 11 441 (61%) enrolled. Of the participants, 9756 answered the questionnaire for those who work and 1685 answered the version for non-workers. FINDINGS: The most important findings are that 31% in the working population and 36% in the non-working population report either hearing loss or tinnitus or both. The prevalence of hearing problems increases with age, is higher among men and persons with low self-rated SES, and covaries with exposure to noise at work. Severe hearing problems are already present in men and women under 40 years of age who are exposed to work-related noise. INTERPRETATION: Prevalence of hearing problems is far more common than previously estimated and is associated with SES and noise exposure history. Hearing problems have a gradual onset that can take years to become recognised. In order to proactively intervene and prevent this deleterious, yet avoidable handicap, statistics need to be regularly updated.

  • 33. Heikkila, K.
    et al.
    Madsen, I. E. H.
    Nyberg, S. T.
    Fransson, E. I.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerholm, P. J. M.
    Virtanen, M.
    Vahtera, J.
    Vaananen, A.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Suominen, S. B.
    Shipley, M. J.
    Salo, P.
    Rugulies, R.
    Pentti, J.
    Pejtersen, J. H.
    Oksanen, T.
    Nordin, M.
    Nielsen, M. L.
    Kouvonen, A.
    Koskinen, A.
    Koskenvuo, M.
    Knutsson, A.
    Ferrie, J. E.
    Dragano, N.
    Burr, H.
    Borritz, M.
    Bjorner, J. B.
    Alfredsson, L.
    Batty, G. D.
    Singh-Manoux, A.
    Kivimaki, M.
    Job strain and the risk of severe asthma exacerbations: a meta-analysis of individual-participant data from 100 000 European men and women2014In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, no 6, p. 775-783Article in journal (Refereed)
    Abstract [en]

    BackgroundMany patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women. MethodsWe analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses. ResultsDuring a median follow-up of 10years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19). ConclusionsOur findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.

  • 34. Heikkila, Katriina
    et al.
    Nyberg, Solja T.
    Madsen, Ida E. H.
    de Vroome, Ernest
    Alfredsson, Lars
    Bjorner, Jacob J.
    Borritz, Marianne
    Burr, Hermann
    Erbel, Raimund
    Ferrie, Jane E.
    Fransson, Eleonor I.
    Geuskens, Goedele A.
    Hooftman, Wendela E.
    Houtman, Irene L.
    Jöckel, Karl-Heinz
    Knutsson, Anders
    Koskenvuo, Markku
    Lunau, Thorsten
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Shipley, Martin J.
    Steptoe, Andrew
    Suominen, Sakari B.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Dragano, Nico
    Rugulies, Reiner
    Kawachi, Ichiro
    Batty, G. David
    Singh-Manoux, Archana
    Virtanen, Marianna
    Kivimäki, Mika
    Long working hours and cancer risk: a multi-cohort study2016In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 114, p. 813-818Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Working longer than the maximum recommended hours is associated with an increased risk of cardiovascular disease, but the relationship of excess working hours with incident cancer is unclear.

    METHODS: This multi-cohort study examined the association between working hours and cancer risk in 116 462 men and women who were free of cancer at baseline. Incident cancers were ascertained from national cancer, hospitalisation and death registers; weekly working hours were self-reported.

    RESULTS: During median follow-up of 10.8 years, 4371 participants developed cancer (n colorectal cancer: 393; n lung cancer: 247; n breast cancer: 833; and n prostate cancer: 534). We found no clear evidence for an association between working hours and the overall cancer risk. Working hours were also unrelated the risk of incident colorectal, lung or prostate cancers. Working ⩾55 h per week was associated with 1.60-fold (95% confidence interval 1.12-2.29) increase in female breast cancer risk independently of age, socioeconomic position, shift- and night-time work and lifestyle factors, but this observation may have been influenced by residual confounding from parity.

    CONCLUSIONS: Our findings suggest that working long hours is unrelated to the overall cancer risk or the risk of lung, colorectal or prostate cancers. The observed association with breast cancer would warrant further research.

  • 35. Heikkilä, Katriina
    et al.
    Madsen, Ida E. H.
    Nyberg, Solja T.
    Fransson, Eleonor I.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Ahola, Kirsi
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Ferrie, Jane E.
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Nielsen, Martin L.
    Nordin, Maria
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Oksanen, Tuula
    Shipley, Martin J.
    Suominen, Sakari B.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Väänänen, Ari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerholm, Peter J. M.
    Batty, G. David
    Singh-Manoux, Archana
    Kivimäki, Mika
    Job Strain and the Risk of Inflammatory Bowel Diseases: Individual-Participant Meta-Analysis of 95 000 Men and Women2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 2, article id e88711Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Many clinicians, patients and patient advocacy groups believe stress to have a causal role in inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. However, this is not corroborated by clear epidemiological research evidence. We investigated the association between work-related stress and incident Crohn's disease and ulcerative colitis using individual-level data from 95 000 European adults. Methods: We conducted individual-participant data meta-analyses in a set of pooled data from 11 prospective European studies. All studies are a part of the IPD-Work Consortium. Work-related psychosocial stress was operationalised as job strain (a combination of high demands and low control at work) and was self-reported at baseline. Crohn's disease and ulcerative colitis were ascertained from national hospitalisation and drug reimbursement registers. The associations between job strain and inflammatory bowel disease outcomes were modelled using Cox proportional hazards regression. The study-specific results were combined in random effects meta-analyses. Results: Of the 95 379 participants who were free of inflammatory bowel disease at baseline, 111 men and women developed Crohn's disease and 414 developed ulcerative colitis during follow-up. Job strain at baseline was not associated with incident Crohn's disease (multivariable-adjusted random effects hazard ratio: 0.83, 95% confidence interval: 0.48, 1.43) or ulcerative colitis (hazard ratio: 1.06, 95% CI: 0.76, 1.48). There was negligible heterogeneity among the study-specific associations. Conclusions: Our findings suggest that job strain, an indicator of work-related stress, is not a major risk factor for Crohn's disease or ulcerative colitis.

  • 36. Heikkilä, Katriina
    et al.
    Madsen, Ida E H
    Nyberg, Solja T
    Fransson, Eleonor I
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ahola, Kirsi
    Alfredsson, Lars
    Bjorner, Jakob B
    Borritz, Marianne
    Burr, Hermann
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Nielsen, Martin L
    Nordin, Maria
    Pahkin, Krista
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J
    Suominen, Sakari B
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Väänänen, Ari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter J M
    Batty, G David
    Singh-Manoux, Archana
    Kivimäki, Mika
    Job strain and COPD exacerbations: an individual-participant meta-analysis2014In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 44, no 1, p. 247-251Article in journal (Refereed)
  • 37. Heikkilä, Katriina
    et al.
    Nyberg, Solja T.
    Fransson, Eleonor I.
    Alfredsson, Lars
    De Bacquer, Dirk
    Bjorner, Jakob B.
    Bonenfant, Sebastien
    Borritz, Marianne
    Burr, Hermann
    Clays, Els
    Casini, Annalisa
    Dragano, Nico
    Erbel, Raimund
    Geuskens, Goedele A.
    Goldberg, Marcel
    Hooftman, Wendela E.
    Houtman, Irene L.
    Joensuu, Matti
    Joeckel, Karl-Heinz
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lunau, Thorsten
    Madsen, Ida E. H.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Marmot, Michael G.
    Nielsen, Martin L.
    Nordin, Maria
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Siegrist, Johannes
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Vaananen, Ari
    Westerholm, Peter
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. University College London, United Kingdom.
    Zins, Marie
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hamer, Mark
    Ferrie, Jane E.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimäki, Mika
    Job Strain and Alcohol Intake: A Collaborative Meta-Analysis of Individual-Participant Data from 140 000 Men and Women2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 7, p. e40101-Article in journal (Refereed)
    Abstract [en]

    Background: The relationship between work-related stress and alcohol intake is uncertain. In order to add to the thus far inconsistent evidence from relatively small studies, we conducted individual-participant meta-analyses of the association between work-related stress (operationalised as self-reported job strain) and alcohol intake. Methodology and Principal Findings: We analysed cross-sectional data from 12 European studies (n = 142 140) and longitudinal data from four studies (n = 48 646). Job strain and alcohol intake were self-reported. Job strain was analysed as a binary variable (strain vs. no strain). Alcohol intake was harmonised into the following categories: none, moderate (women: 1-14, men: 1-21 drinks/week), intermediate (women: 15-20, men: 22-27 drinks/week) and heavy (women: > 20, men: > 27 drinks/week). Cross-sectional associations were modelled using logistic regression and the results pooled in random effects meta-analyses. Longitudinal associations were examined using mixed effects logistic and modified Poisson regression. Compared to moderate drinkers, non-drinkers and (random effects odds ratio (OR): 1.10, 95% CI: 1.05, 1.14) and heavy drinkers (OR: 1.12, 95% CI: 1.00, 1.26) had higher odds of job strain. Intermediate drinkers, on the other hand, had lower odds of job strain (OR: 0.92, 95% CI: 0.86, 0.99). We found no clear evidence for longitudinal associations between job strain and alcohol intake. Conclusions: Our findings suggest that compared to moderate drinkers, non-drinkers and heavy drinkers are more likely and intermediate drinkers less likely to report work-related stress.

  • 38. Heikkilä, Katriina
    et al.
    Nyberg, Solja T.
    Fransson, Eleonor I.
    Alfredsson, Lars
    De Bacquer, Dirk
    Bjorner, Jakob B.
    Bonenfant, Sebastien
    Borritz, Marianne
    Burr, Hermann
    Clays, Els
    Casini, Annalisa
    Dragano, Nico
    Erbel, Raimund
    Geuskens, Goedele A.
    Goldberg, Marcel
    Hooftman, Wendela E.
    Houtman, Irene L.
    Joensuu, Matti
    Jöckel, Karl-Heinz
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lunau, Thorsten
    Madsen, Ida E. H.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Marmot, Michael G.
    Nielsen, Martin L.
    Nordin, Maria
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Siegrist, Johannes
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Vaananen, Ari
    Westerholm, Peter
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. University College London, UK.
    Zins, Marie
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hamer, Mark
    Ferrie, Jane E.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimäki, Mika
    Job Strain and Tobacco Smoking: An Individual-Participant Data Meta-Analysis of 166 130 Adults in 15 European Studies2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 7, article id e35463Article in journal (Refereed)
    Abstract [en]

    Background: Tobacco smoking is a major contributor to the public health burden and healthcare costs worldwide, but the determinants of smoking behaviours are poorly understood. We conducted a large individual-participant meta-analysis to examine the extent to which work-related stress, operationalised as job strain, is associated with tobacco smoking in working adults. Methodology and Principal Findings: We analysed cross-sectional data from 15 European studies comprising 166 130 participants. Longitudinal data from six studies were used. Job strain and smoking were self-reported. Smoking was harmonised into three categories never, ex- and current. We modelled the cross-sectional associations using logistic regression and the results pooled in random effects meta-analyses. Mixed effects logistic regression was used to examine longitudinal associations. Of the 166 130 participants, 17% reported job strain, 42% were never smokers, 33% ex-smokers and 25% current smokers. In the analyses of the cross-sectional data, current smokers had higher odds of job strain than never-smokers (age, sex and socioeconomic position-adjusted odds ratio: 1.11, 95% confidence interval: 1.03, 1.18). Current smokers with job strain smoked, on average, three cigarettes per week more than current smokers without job strain. In the analyses of longitudinal data (1 to 9 years of follow-up), there was no clear evidence for longitudinal associations between job strain and taking up or quitting smoking. Conclusions: Our findings show that smokers are slightly more likely than non-smokers to report work-related stress. In addition, smokers who reported work stress smoked, on average, slightly more cigarettes than stress-free smokers.

  • 39. Heikkilä, Katriina
    et al.
    Nyberg, Solja T.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Fransson, Eleonor I.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Alfredsson, Lars
    Bjorner, Jakob B.
    Bonenfant, Sebastien
    Borritz, Marianne
    Bouillon, Kim
    Burr, Herman
    Dragano, Nico
    Geuskens, Goedele A.
    Goldberg, Marcel
    Hamer, Mark
    Hooftman, Wendela E.
    Houtman, Irene L.
    Joensuu, Matti
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Madsen, Ida E. H.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Marmot, Michael G.
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Salo, Paula
    Rugulies, Reiner
    Steptoe, Andrew
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Väänänen, Ari
    Westerholm, Peter
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Zins, Marie
    Ferrie, Jane E.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimäki, Mika
    Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116 000 European men and women2013In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 346, article id f165Article in journal (Refereed)
    Abstract [en]

    Objective To investigate whether work related stress, measured and defined as job strain, is associated with the overall risk of cancer and the risk of colorectal, lung, breast, or prostate cancers. Design Meta-analysis of pooled prospective individual participant data from 12 European cohort studies including 116 056 men and women aged 17-70 who were free from cancer at study baseline and were followed-up for a median of 12 years. Work stress was measured and defined as job strain, which was self reported at baseline. Incident cancers (all n=5765, colorectal cancer n=522, lung cancer n=374, breast cancer n=1010, prostate cancer n=865) were ascertained from cancer, hospital admission, and death registers. Data were analysed in each study with Cox regression and the study specific estimates pooled in meta-analyses. Models were adjusted for age, sex, socioeconomic position, body mass index (BMI), smoking, and alcohol intake Results A harmonised measure of work stress, high job strain, was not associated with overall risk of cancer (hazard ratio 0.97, 95% confidence interval 0.90 to 1.04) in the multivariable adjusted analyses. Similarly, no association was observed between job strain and the risk of colorectal (1.16, 0.90 to 1.48), lung (1.17, 0.88 to 1.54), breast (0.97, 0.82 to 1.14), or prostate (0.86, 0.68 to 1.09) cancers. There was no clear evidence for an association between the categories of job strain and the risk of cancer. Conclusions These findings suggest that work related stress, measured and defined as job strain, at baseline is unlikely to be an important risk factor for colorectal, lung, breast, or prostate cancers.

  • 40. Henje Blom, Eva C
    et al.
    Serlachius, Eva
    Larsson, Jan-Olov
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ingvar, Martin
    Low Sense of Coherence (SOC) is a mirror of general anxiety and persistent depressive symptoms in adolescent girls - a cross-sectional study of a clinical and a non-clinical cohort2010In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 8, p. 58-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Sense of Coherence (SOC) scale is assumed to measure a distinct salutogenic construct separated from measures of anxiety and depression. Our aim was to challenge this concept. METHODS: The SOC-scale, Beck's Depression Inventory (BDI), Beck's Anxiety Inventory (BAI) , the emotional subscale of the Strengths and Difficulties Questionnaire (SDQ-em) and self-assessed health-related and physiological parameters were collected from a sample of non-clinical adolescent females (n = 66, mean age 16.5 years with a range of 15.9-17.7 years) and from female psychiatric patients (n = 73), mean age 16.8 years with a range of 14.5-18.4 years), with diagnoses of major depressive disorders (MDD) and anxiety disorders. RESULTS: The SOC scores showed high inverse correlations to BDI, BAI and SDQ-em. In the non-clinical sample the correlation coefficient was -0.86 to -0.73 and in the clinical samples -0.74 to -0.53 (p < 0.001). Multiple regression models showed that BDI was the strongest predictor of SOC in the non-clinical (beta coefficient -0.47) and clinical sample (beta coefficient -0.52). The total degree of explanation of self assessed anxiety and depression on the SOC variance estimated by multiple R2 = 0.74, adjusted R2 = 0.73 in the non-clinical sample and multiple R2 = 0.66, adjusted R2 = 0.65 in the clinical sample.Multivariate analyses failed to isolate SOC as a separate construct and the SOC-scale, BDI, BAI and SDQ-em showed similar patterns of correlations to self-reported and physiological health parameters in both samples. The SOC-scale was the most stable measure over six months. CONCLUSIONS: The SOC-scale did not appear to be a measure of a distinct salutogenic construct, but an inverse measure of persistent depressive symptoms and generalized social anxiety similar to the diagnostic criteria for major depressive disorder (MDD), dysthymic disorder, generalized anxiety disorder (GAD) or generalized social anxiety disorder (SAD) according to DSM-IV. These symptoms were better captured with SOC than by the specialized scales for anxiety and depression. Self-assessment scales that adequately identify MDD, dysthymic disorder, GAD and SAD need to be implemented. Comorbidity of these disorders is common in adolescent females and corresponds to a more severe symptomatology and impaired global function.

  • 41. Hintsanen, M
    et al.
    Kivimäki, M
    Hintsa, T
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Elovainio, M
    Raitakari, O T
    Viikari, J S A
    Keltikangas-Järvinen, L
    A prospective cohort study of deficient maternal nurturing attitudes predicting adulthood work stress independent of adulthood hostility and depressive symptoms2010In: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 13, no 5, p. 425-34Article in journal (Refereed)
    Abstract [en]

    Stressful childhood environments arising from deficient nurturing attitudes are hypothesized to contribute to later stress vulnerability. We examined whether deficient nurturing attitudes predict adulthood work stress. Participants were 443 women and 380 men from the prospective Cardiovascular Risk in Young Finns Study. Work stress was assessed as job strain and effort-reward imbalance in 2001 when the participants were from 24 to 39 years old. Deficient maternal nurturance (intolerance and low emotional warmth) was assessed based on mothers' reports when the participants were at the age of 3-18 years and again at the age of 6-21 years. Linear regressions showed that deficient emotional warmth in childhood predicted lower adulthood job control and higher job strain. These associations were not explained by age, gender, socioeconomic circumstances, maternal mental problems or participant hostility, and depressive symptoms. Deficient nurturing attitudes in childhood might affect sensitivity to work stress and selection into stressful work conditions in adulthood. More attention should be paid to pre-employment factors in work stress research.

  • 42. Hébert, Sylvie
    et al.
    Canlon, Barbara
    Hasson, Dan
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Tinnitus severity is reduced with reduction of depressive mood - a prospective population study in Sweden2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 5, article id e37733Article in journal (Refereed)
    Abstract [en]

    Tinnitus, the perception of sound without external source, is a highly prevalent public health problem with about 8% of the population having frequently occurring tinnitus, and about 1-2% experiencing significant distress from it. Population studies, as well as studies on self-selected samples, have reported poor psychological well-being in individuals with tinnitus. However, no study has examined the long-term co-variation between mood and tinnitus prevalence or tinnitus severity. In this study, the relationship between depression and tinnitus prevalence and severity over a 2-year period was examined in a representative sample of the general Swedish working population. Results show that a decrease in depression is associated with a decrease in tinnitus prevalence, and even more markedly with tinnitus severity. Hearing loss was a more potent predictor than depression for tinnitus prevalence, but was a weaker predictor than depression for tinnitus severity. In addition, there were sex differences for tinnitus prevalence, but not for tinnitus severity. This study shows a direct and long-term association between tinnitus severity and depression.

  • 43. Karlson, Björn
    et al.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Riva, Roberto
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Mellner, Christin
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lundberg, Ulf
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Psychosocial work stressors and salivary cortisol2012In: The role of saliva cortisol measurement in health and disease / [ed] Margareta Kristenson, Peter Garvin, Ulf Lundberg, Sharjah: Bentham Science , 2012, 1, p. 43-66Chapter in book (Other academic)
    Abstract [en]

    This chapter systematically reviews how different measures of salivary cortisol are related to different measures of psychosocial work stress. Divergent findings were scrutinized with respect to study quality and the methods used. Measures of work stress included concepts reflecting those included in the demand–control–support model or the effort–reward–imbalance model. General bibliographic databases (PsychINFO and PubMed) were searched up to September 30, 2009. Two reviewers extracted data on study characteristics and study quality. In total 27 articles fulfilled the inclusion criteria. Cortisol measures were grouped into single time points at different times during the day, deviations at different time periods during the day, reactivity and recovery after a standardized laboratory test, area under the curve from deviations and reactivity measures. A large proportion of the analyses of the associations between cortisol and psychosocial work stressors showed nonsignificant findings. However, of the significant findings, most results showed that a high work stress was associated with high cortisol levels. Significant relationships were evenly distributed across different measures of psychosocial work stress. As regards salivary sampling or statistical analysis, no strategy seemed superior but some strategies have only been used in the past few years. Typically, older studies were of lower quality. Low quality studies tended to have a higher proportion of significant findings which is a reason for concern. The relatively few significant findings may be because many psychosocial work stressors were of mild or moderate intensity and the study groups were rather small and fairly homogeneous, thus variability was too small to reveal any effects. The results indicate a normal, healthy response to work stress in most workers, according to CATS and the Allostatic Load Models.

  • 44. Kempe, Annica
    et al.
    Noor-Aldin Alwazer, Fatoom A
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Women's authority during childbirth and Safe Motherhood in Yemen2010In: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, ISSN 1877-5764, Vol. 1, no 4, p. 129-34Article in journal (Refereed)
    Abstract [en]

    This paper argues that supporting Yemeni women to exercise their own authority during childbirth would significantly facilitate their ability to give birth successfully and with personal satisfaction. In a country where women are routinely disempowered, their personal empowerment at birth is very important to them. Skilled birth assistants often, in women's perceptions, work against their personal power and authority, most especially MDs but also midwives. This failure results in women failing to seek medical care when needed. Supporting women to experience their own authority at birth would facilitate the accomplishment of both the Millennium Development Goals and those of the Safe Motherhood Initiative. We call for increased cooperation between modern and traditional methods of care.

  • 45. Kempe, Annica
    et al.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Noor-Aldin Alwazer, Fatoom
    Christensson, Kyllike
    Johansson, Annika
    Yemeni women's perceptions of own authority during childbirth: what does it have to do with achieving the Millennium Development Goals?2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 10, p. 1182-1189Article in journal (Refereed)
    Abstract [en]

    Background: women's underutilisation of professional care during childbirth in many low-income countries is a serious concern in terms of achievement of maternal Millennium Development Goal 5.

    Objective: to explore women's perceived own authority within the modern and traditional spheres of childbirth in a high maternal mortality setting on the Arab peninsula. Yemen is a signatory to the Millennium Development Goals and one of 10 countries chosen for the United Nations Millennium Project. In Yemen, home birth has remained the norm for several decades in spite of high maternal mortality and morbidity rates.

    Design: a multistage (stratified-purposive-random) sampling process was used. Two hundred and twenty women with childbirth experience in urban/rural Yemen were selected at random for interview. Answers to the question 'Did you feel that you were the authority during childbirth?' were analysed using qualitative content analysis.

    Setting: the governorates of Aden, Lahej, Hadramout, Taiz and Hodeidah.

    Findings: three main themes emerged from the analysis: (i) 'Being at the centre', including two categories 'being able to follow through on own wants' and its opposite 'to be under the authority of others'; (ii) 'A sense of belonging' with the categories 'belonging and support among women in the community' and 'the denial of support, the experience of separation' and (iii) 'Husband's role in childbirth' including one category 'opportunity to show authority over the husband'. Authority was experienced primarily among women within the traditional childbirth sector although a general complaint among women delivered by trained medical staff was the loss of own authority.

    Key conclusions and implications for practice: these findings show that women's authority during childbirth is decreasing in the context of Safe Motherhood and the expansion of modern delivery care. This is likely to be an important reason why women underutilise professional care. Acquisition of knowledge from the traditional childbirth sector regarding how women exercise authority to facilitate childbirth would constitute an asset to skilled delivery and Safe Motherhood. The findings from Yemen are likely to be relevant for other low-income countries with similar persistent high home delivery rates, low status of women, and high maternal mortality and morbidity rates.

  • 46. Kivimäki, Mika
    et al.
    Jokela, Markus
    Nyberg, Solja T.
    Singh-Manoux, Archana
    Fransson, Eleonor I.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Casini, Annalisa
    Clays, Els
    De Bacquer, Dirk
    Dragano, Nico
    Erbel, Raimund
    Geuskens, Goedele A.
    Hamer, Mark
    Hooftman, Wendela E.
    Houtman, Irene L.
    Jöckel, Karl-Heinz
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Lunau, Thorsten
    Madsen, Ida E. H.
    Nielsen, Martin L.
    Nordin, Maria
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Umeå University, Sweden.
    Oksanen, Tuula
    Pejtersen, Jan H.
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J.
    Siegrist, Johannes
    Steptoe, Andrew
    Suominen, Sakari B.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Vahtera, Jussi
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    O'Reilly, Dermot
    Kumari, Meena
    Batty, G. David
    Ferrie, Jane E.
    Virtanen, Marianna
    Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10005, p. 1739-1746Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke.

    METHODS: We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.

    FINDINGS: We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603,838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528,908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001).

    INTERPRETATION: Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.

    FUNDING: Medical Research Council, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), US National Institutes of Health, British Heart Foundation.

  • 47. Kivimäki, Mika
    et al.
    Luukkonen, Ritva
    Batty, G. David
    Ferrie, Jane E.
    Pentti, Jaana
    Nyberg, Solja T.
    Shipley, Martin J.
    Alfredsson, Lars
    Fransson, Eleonor
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Goldberg, Marcel
    Knutsson, Anders
    Koskenvuo, Markku
    Kuosma, Eeva
    Nordin, Maria
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Umeå University, Sweden.
    Suominen, Sakari B.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Vuoksimaa, Eero
    Westerholm, Peter
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Zins, Marie
    Kivipelto, Miia
    Vahtera, Jussi
    Kaprio, Jaakko
    Singh-Manoux, Archana
    Jokela, Markus
    Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals2018In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 14, no 5, p. 601-609Article in journal (Refereed)
    Abstract [en]

    Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects.

    Methods: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis.

    Results: Hazard ratios per 5-kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and >20 years before dementia diagnosis.

    Conclusions: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short.

  • 48. Kivimäki, Mika
    et al.
    Nyberg, Solja T.
    Batty, G. David
    Fransson, Eleonor I.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Heikkilä, Katriina
    Alfredsson, Lars
    Bjørner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Casini, Annalisa
    Clays, Els
    De Bacquer, Dirk
    Dragano, Nico
    Ferrie, Jane E.
    Geuskens, Goedele A.
    Goldberg, Marcel
    Hamer, Mark
    Hooftman, Wendela E.
    Houtman, Irene L.
    Joensuu, Matti
    Jokela, Markus
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kouvonen, Anne
    Kumari, Meena
    Madsen, Ida E. H.
    Marmot, Michael G.
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Singh-Manoux, Archana
    Suominen, Sakari B.
    Väänänen, Ari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Zins, Marie
    Steptoe, Andrew
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data2012In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 380, no 9852, p. 1491-1497Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies.

    METHODS: We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death.

    FINDINGS: 30 214 (15%) of 197 473 participants reported job strain. In 1·49 million person-years at risk (mean follow-up 7·5 years [SD 1·7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1·23 (95% CI 1·10-1·37). This effect estimate was higher in published (1·43, 1·15-1·77) than unpublished (1·16, 1·02-1·32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1·31, 1·15-1·48) and 5 years (1·30, 1·13-1·50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3·4%.

    INTERPRETATION: Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking.

  • 49. Kivimäki, Mika
    et al.
    Nyberg, Solja T
    Batty, G David
    Kawachi, Ichiro
    Jokela, Markus
    Alfredsson, Lars
    Bjorner, Jakob B
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Fransson, Eleonor
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Jönköping University, Sweden.
    Heikkilä, Katriina
    Knutsson, Anders
    Koskenvuo, Markku
    Kumari, Meena
    Madsen, Ida E H
    Nielsen, Martin L
    Nordin, Maria
    Oksanen, Tuula
    Pejtersen, Jan H
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J
    Suominen, Sakari
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Vahtera, Jussi
    Westerholm, Peter
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Steptoe, Andrew
    Singh-Manoux, Archana
    Hamer, Mark
    Ferrie, Jane E
    Virtanen, Marianna
    Tabak, Adam G
    Long working hours as a risk factor for atrial fibrillation: a multi-cohort study2017In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 34, p. 2621-2628Article in journal (Refereed)
    Abstract [en]

    Aims: Studies suggest that people who work long hours are at increased risk of stroke, but the association of long working hours with atrial fibrillation, the most common cardiac arrhythmia and a risk factor for stroke, is unknown. We examined the risk of atrial fibrillation in individuals working long hours (≥55 per week) and those working standard 35-40 h/week.

    Methods and results: In this prospective multi-cohort study from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium, the study population was 85 494 working men and women (mean age 43.4 years) with no recorded atrial fibrillation. Working hours were assessed at study baseline (1991-2004). Mean follow-up for incident atrial fibrillation was 10 years and cases were defined using data on electrocardiograms, hospital records, drug reimbursement registers, and death certificates. We identified 1061 new cases of atrial fibrillation (10-year cumulative incidence 12.4 per 1000). After adjustment for age, sex and socioeconomic status, individuals working long hours had a 1.4-fold increased risk of atrial fibrillation compared with those working standard hours (hazard ratio = 1.42, 95% CI = 1.13-1.80, P = 0.003). There was no significant heterogeneity between the cohort-specific effect estimates (I2 = 0%, P = 0.66) and the finding remained after excluding participants with coronary heart disease or stroke at baseline or during the follow-up (N = 2006, hazard ratio = 1.36, 95% CI = 1.05-1.76, P = 0.0180). Adjustment for potential confounding factors, such as obesity, risky alcohol use and high blood pressure, had little impact on this association.

    Conclusion: Individuals who worked long hours were more likely to develop atrial fibrillation than those working standard hours.

  • 50. Kivimäki, Mika
    et al.
    Nyberg, Solja T.
    Fransson, Eleonor I.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Jönköping University, Sweden.
    Heikkila, Katriina
    Alfredsson, Lars
    Casini, Annalisa
    Clays, Els
    De Bacquer, Dirk
    Dragano, Nico
    Ferrie, Jane E.
    Goldberg, Marcel
    Hamer, Mark
    Jokela, Markus
    Karasek, Robert
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Suominen, Sakari B.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Vahtera, Jussi
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. University of Turku, Finland.
    Virtanen, Marianna
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Zins, Marie
    Steptoe, Andrew
    Singh-Manoux, Archana
    Batty, G. David
    Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data2013In: CMJA. Canadian Medical Association Journal. Onlineutg. Med tittel: ECMAJ. ISSN 1488-2329, ISSN 0820-3946, E-ISSN 1488-2329, Vol. 185, no 9, p. 763-769Article in journal (Refereed)
    Abstract [en]

    Background: It is unclear whether a healthy lifestyle mitigates the adverse effects of job strain on coronary artery disease. We examined the associations of job strain and lifestyle risk factors with the risk of coronary artery disease. Methods: We pooled individual-level data from 7 cohort studies comprising 102 128 men and women who were free of existing coronary artery disease at baseline (1985-2000). Questionnaires were used to measure job strain (yes v. no) and 4 lifestyle risk factors: current smoking, physical inactivity, heavy drinking and obesity. We grouped participants into 3 lifestyle categories: healthy (no lifestyle risk factors), moderately unhealthy (1 risk factor) and unhealthy (2-4 risk factors). The primary outcome was incident coronary artery disease (defined as first nonfatal myocardial infarction or cardiac-related death). Results: There were 1086 incident events in 743 948 person-years at risk during a mean follow-up of 7.3 years. The risk of coronary artery disease among people who had an unhealthy lifestyle compared with those who had a healthy lifestyle (hazard ratio [HR] 2.55, 95% confidence interval [CI] 2.18-2.98; population attributable risk 26.4%) was higher than the risk among participants who had job strain compared with those who had no job strain (HR 1.25, 95% CI 1.06-1.47; population attributable risk 3.8%). The 10-year incidence of coronary artery disease among participants with job strain and a healthy lifestyle (14.7 per 1000) was 53% lower than the incidence among those with job strain and an unhealthy lifestyle (31.2 per 1000). Interpretation: The risk of coronary artery disease was highest among participants who reported job strain and an unhealthy lifestyle; those with job strain and a healthy lifestyle had half the rate of disease. A healthy life style may substantially reduce disease risk among people with job strain.

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