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  • 51.
    Axelsson, Martin
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    HR-medarbetares upplevelser kring spelprevention och policyimplementering på arbetsplatsen2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The complex concept regarding harmful use of different nature, could be related to the use of alcohol, drugs or gambling. Such activities could affect the efficiency and productivity of an employee in a workplace environment in a negative way. At the request of the Public Health Agency of Sweden, a group of scientist was given the task to evaluate a project regarding education concerning problematic gambling. The purpose of the current study is to evaluate a project regarding education concerning gambling and gambling prevention, and was carried out by the organization Alna. Thematic analysis was used and collection of data was done with semi structured interviews, with ten HR-employees whose five organisations was included in the project Gambling and gambling preventive efforts directed towards the labour market. The results show that the methods and tools used by Alna is perceived as efficient and valuable by the participants. Some obstacles which works against efficient implementation of updated policies and guidelines were identified and these could consist of time constraints, under staffing or subordinated priority of the gambling issue per se. Furthermore it seems that the education project regarding gambling prevention performed by Alna has contributed to the development of policies and guidelines regarding harmful use of different kinds with focus on the gambling issue.  

  • 52. Babor, Thomas
    et al.
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Health services: Treatment of substance use disorders within health services2010In: ATLAS on substance use (2010): Resources for the prevention and treatment of substance use disorders / [ed] Wolrd Health Organization, WHO Library Cataloguing-in-Publication Data , 2010, p. 23-25Chapter in book (Other academic)
    Abstract [en]

    http://www.who.int/substance_abuse/publications/treatment/en/index.html

  • 53. Barghadouch, Amina
    et al.
    Kristiansen, Maria
    Smith Jervelund, Signe
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Montgomery, Edith
    Norredam, Marie
    Refugee children have fewer contacts to psychiatric healthcare services: an analysis of a subset of refugee children compared to Danish-born peers2016In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 51, no 8, p. 1125-1136Article in journal (Refereed)
    Abstract [en]

    Studies show a high level of mental health problems among refugee children. This study examined whether a subset of refugee children living in Denmark accessed psychiatric healthcare services more than those born in the country. This study compared 24,427 refugee children from Asia, The Middle East, Sub-Saharan Africa and former Yugoslavia, who obtained residency in Denmark between 1 January 1993 and 31 December 2010 with 146,562 Danish-born children, matched 1:6 on age and sex. The study looked at contacts with psychiatric hospitals as well as psychologists and psychiatrists in private practice. Between 1 January 1996 and 30 June 2012, 3.5 % of the refugee children accessed psychiatric healthcare services compared to 7.7 % of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95 % CI 0.40-0.45) among refugee boys and 0.35 (95 % CI 0.33-0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services. Refugee children used fewer psychiatric healthcare services than Danish-born children. This may indicate that refugee children experience barriers in accessing psychiatric healthcare systems and do not receive adequate assessment of their mental health and subsequent referral to specialist services.

  • 54.
    Barrett, Damon
    Stockholm University, Faculty of Law, Department of Law. University of Essex, UK.
    Re: ‘Access to treatment with controlled medicines: rationale and recommendations for neutral, precise, and respectful language’2018In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 160, p. 156-156Article in journal (Other academic)
  • 55.
    Barrett, Damon
    Stockholm University, Faculty of Law, Department of Law. University of Essex, UK.
    The Child's Right to Protection from Drugs: Understanding History to Move Forward2017In: Health and Human Rights: An International Journal, ISSN 1079-0969, E-ISSN 2150-4113, Vol. 19, no 1, p. 263-268Article in journal (Refereed)
  • 56.
    Bartonek, Frida
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    The role of self-esteem for the relation between school performance and psychosomatic health in adolescence: Sex differences and gender theoretical interpretations2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    While socioeconomic inequalities in health seem to level out during adolescence, circumstances related to school appears to have increased in importance. Such circumstances include, for example, school performance. The primary aim of this study is to examine the relationship between school performance and psychosomatic health. The moderating role of self-esteem and the presence of any sex differences will additionally be investigated. Data from the Stockholm School Survey in 2004, covering a total sample of 5 135 adolescents in 9th grade, were used. Based on linear regression, a significant association between school marks and psychosomatic health was found where higher school performance was linked to better health. Moreover, lower self-esteem was linked to more health complaints. Self-esteem moderated the association between school marks and psychosomatic health but only among boys, for whom the effect of having both high marks and high self-esteem was not as beneficial for health as expected. While differences by sex were found in the distribution of school marks, self-esteem and psychosomatic health, none were found in the associations between self-esteem and school performance and psychosomatic health (the only exception being the moderating role of self-esteem among boys).

  • 57. Beccaria, Franca
    et al.
    Rolando, Sara
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Scavarda, Alice
    From housekeeper to status-oriented consumer and hyper-sexual imagery: images of alcohol targeted to Italian women from the 1960s to the 2000s2017In: Feminist Media Studies, ISSN 1468-0777, E-ISSN 1471-5902Article in journal (Refereed)
    Abstract [en]

    Advertisements not only mirror ideals of masculinity and femininity that prevail in a specific place and time, but also contribute to influencing them. This article analyses alcohol-related advertisements published in women’s magazines from 1967 to 2008 in Italy. The main aim is to understand cultural processes that underlie gender differences in drinking and more generally in Italian society. The sample consists of 376 direct and indirect advertisements collected from well-established women’s magazines. The study identifies continuities and changes in women’s subject positions in alcohol-related advertisements. Italian advertisements of the 1960s and 1970s still reflect a female condition that entails no recognition of women’s own desires and tastes. Advertisements from the 1980s and 1990s reflect a more complex representation of female consumers, associating them with their own desires and pleasures. In the 2000s, the focus on women’s physical appearance and social image has become the prevailing feature. In conclusion, the study shows that changes in female representations in advertisements in the last 50 years do not represent a shift toward a more balanced gender representation. The insistence on women’s appearance, with a correlated predominance of bodily pleasures and attractiveness, reproduces old stereotypes about drinking women.

  • 58.
    Beckley, Amber L.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Duke University, North Carolina.
    Caspi, Avshalom
    Broadbent, Jonathan
    Harrington, Honalee
    Houts, Renate M.
    Poulton, Richie
    Ramrakha, Sandhya
    Reuben, Aaron
    Moffitt, Terrie E.
    Association of Childhood Blood Lead Levels With Criminal Offending2018In: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 172, no 2, p. 166-173Article in journal (Refereed)
    Abstract [en]

    Importance  Lead is a neurotoxin with well-documented effects on health. Research suggests that lead may be associated with criminal behavior. This association is difficult to disentangle from low socioeconomic status, a factor in both lead exposure and criminal offending.

    Objective  To test the hypothesis that a higher childhood blood lead level (BLL) is associated with greater risk of criminal conviction, recidivism (repeat conviction), conviction for violent offenses, and variety of self-reported criminal offending in a setting where BLL was not associated with low socioeconomic status.

    Design, Setting, and Participants  A total of 553 individuals participated in a prospective study based on a population-representative cohort born between April 1, 1972, and March 31, 1973, from New Zealand; the Dunedin Multidisciplinary Health and Development Study observed participants to age 38 years (December 2012). Statistical analysis was performed from November 10, 2016, to September 5, 2017.

    Exposures  Blood lead level measured at age 11 years.

    Main Outcomes and Measures  Official criminal conviction cumulative to age 38 years (data collected in 2013), single conviction or recidivism, conviction for nonviolent or violent crime, and self-reported variety of crime types at ages 15, 18, 21, 26, 32, and 38 years.

    Results  Participants included 553 individuals (255 female and 298 male participants) who had their blood tested for lead at age 11 years. The mean (SD) BLL at age 11 years was 11.01 (4.62) μg/dL. A total of 154 participants (27.8%) had a criminal conviction, 86 (15.6%) had recidivated, and 53 (9.6%) had a violent offense conviction. Variety scores for self-reported offending ranged from 0 to 10 offense types at each assessment; higher numbers indicated greater crime involvement. Self-reported offending followed the well-established age-crime curve (ie, the mean [SD] variety of self-reported offending increased from 1.99 [2.82] at age 15 years to its peak of 4.24 [3.15] at age 18 years and 4.22 [3.02] at age 21 years and declined thereafter to 1.10 [1.59] at age 38 years). Blood lead level was a poor discriminator between no conviction and conviction (area under the curve, 0.58). Overall, associations between BLL and conviction outcomes were weak. The estimated effect of BLL was lower for recidivism than for single convictions and lower for violent offending than for nonviolent offending. Sex-adjusted associations between BLL reached statistical significance for only 1 of the 6 self-reported offending outcomes at age 15 years (r = 0.10; 95% CI, 0.01-0.18; P = .02).

    Conclusions and Relevance  This study overcomes past limitations of studies of BLL and crime by studying the association in a place and time where the correlation was not confounded by childhood socioeconomic status. Findings failed to support a dose-response association between BLL and consequential criminal offending.

  • 59.
    Beckley, Amber L.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Kuja-Halkola, Ralf
    Lundholm, Lena
    Långström, Niklas
    Frisell, Thomas
    Association of height and violent criminality: results from a Swedish total population study2014In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 43, no 3, p. 835-842Article in journal (Refereed)
    Abstract [en]

    Background: Violent criminality is at least moderately heritable, but the mechanisms behind this remain largely unexplained. Height, a highly heritable trait, may be involved but no study has estimated the effect of height on crime while simultaneously accounting for important demographic, biological and other heritable confounders. Methods: We linked nationwide, longitudinal registers for 760 000 men who underwent mandatory military conscription from 1980 through 1992 in Sweden, to assess the association between height and being convicted of a violent crime. We used Cox proportional hazard modelling and controlled for three types of potential confounders: physical characteristics, childhood demographics and general cognitive ability (intelligence). Results: In unadjusted analyses, height had a moderate negative relationship to violent crime; the shortest of men were twice as likely to be convicted of a violent crime as the tallest. However, when simultaneously controlling for all measured confounders, height was weakly and positively related to violent crime. Intelligence had the individually strongest mitigating effect on the height-crime relationship. Conclusions: Although shorter stature was associated with increased risk of violent offending, our analyses strongly suggested that this relationship was explained by intelligence and other confounding factors. Hence, it is unlikely that height, a highly heritable physical characteristic, accounts for much of the unexplained heritability of violent criminality.

  • 60. Beer, Netta
    et al.
    Ali, Abdullah S.
    Eskilsson, Helena
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Jansson, Andreas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Abdul-Kadir, Faiza M.
    Rotllant-Estelrich, Guida
    Abass, Ali K.
    Wabwire-Mangen, Fred
    Björkman, Anders
    Kallander, Karin
    A qualitative study on caretakers' perceived need of bed-nets after reduced malaria transmission in Zanzibar, Tanzania2012In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 12, p. 606-Article in journal (Refereed)
    Abstract [en]

    Background: The elimination of malaria in Zanzibar is highly dependent on sustained effective coverage of bed-nets to avoid malaria resurgence. The Health Belief Model (HBM) framework was used to explore the perceptions of malaria and bed-net use after a noticeable reduction in malaria incidence. Methods: Nineteen in-depth interviews were conducted with female and male caretakers of children under five in North A district, Zanzibar. Deductive content analysis was used to identify meaning units that were condensed, coded and assigned to pre-determined elements of the HBM. Results: Awareness of malaria among caretakers was high but the illness was now seen as easily curable and uncommon. In addition to the perceived advantage of providing protection against malaria, bed-nets were also thought to be useful for avoiding mosquito nuisance, especially during the rainy season when the malaria and mosquito burden is high. The discomfort of sleeping under a net during the hot season was the main barrier that interrupted consistent bed-net usage. The main cue to using a bed-net was high mosquito density, and children were prioritized when it came to bed-net usage. Caretakers had high perceived self-efficacy and did not find it difficult to use bed-nets. Indoor Residual Spraying (IRS), which was recognized as an additional means of mosquito prevention, was not identified as an alternative for bed-nets. A barrier to net ownership was the increasingly high cost of bed-nets. Conclusions: Despite the reduction in malaria incidence and the resulting low malaria risk perceptions among caretakers, the benefit of bed-nets as the most proficient protection against mosquito bites upholds their use. This, in combination with the perceived high self-efficacy of caretakers, supports bed-net usage, while seasonality interrupts consistent use. High effective coverage of bed-nets could be further improved by reinforcing the benefits of bed-nets, addressing the seasonal heat barrier by using nets with larger mesh sizes and ensuring high bed-net ownership rates through sustainable and affordable delivery mechanisms.

  • 61. Beijer, Ulla
    et al.
    Scheffel Birath, Christina
    DeMartinis, Valerie
    af Klinteberg, Britt
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institutet, Sweden.
    Facets of Male Violence Against Women With Substance Abuse Problems: Women With a Residence and Homeless Women2018In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518, Vol. 33, no 9, p. 1391-1411Article in journal (Refereed)
    Abstract [en]

    The aims of this study were to investigate the type and extent to which women with substance abuse problems have been exposed to male violence during their lifetime, and to examine possible differences between women with a residence (WR) and homeless women (HW). The total sample included 79 women (WR, n = 35; HW, n = 44; M age = 47.8 years). Of the total sample, 72 women (91%) had experienced different kinds of male violence, 88% from former partners, and 26% from male friends or acquaintances. Of the 72 women, 71% further reported “Countless occasions of violent events,” and 36% had been forced to commit criminal acts. Abused women who had been forced to commit criminal acts were significantly more frequently found to be homeless, have reported parental alcohol and/or drug problems, have witnessed domestic violence in childhood, have been victims of sexual violence, have used illicit drugs as a dominant preparation, and have injected illicit drugs. Almost half of the abused women (46%) met criteria for posttraumatic stress disorder (PTSD), where HW showed an almost 4-time higher risk (RR 3.78) than WR. In conclusion there is a particular vulnerability in women with substance abuse to male violence, which has an important impact on their health status. Thus, from a public health perspective, it is suggested that for those women who have experienced male violence, treatment protocols need to include both assessing and addressing the impact of such experience in relation to substance abuse as well as concomitant health concerns.

  • 62. Beishuizen, Cathrien R. L.
    et al.
    Stephan, Blossom C. M.
    van Gool, Willem A.
    Brayne, Carol
    Peters, Ron J. G.
    Andrieu, Sandrine
    Kivipelto, Miia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Soininen, Hilkka
    Busschers, Wim B.
    van Charante, Eric P. Moll
    Richard, Edo
    Web-Based Interventions Targeting Cardiovascular Risk Factors in Middle-Aged and Older People: A Systematic Review and Meta-Analysis2016In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 18, no 3, article id e55Article, review/survey (Refereed)
    Abstract [en]

    Background: Web-based interventions can improve single cardiovascular risk factors in adult populations. In view of global aging and the associated increasing burden of cardiovascular disease, older people form an important target population as well.

    Objective: In this systematic review and meta-analysis, we evaluated whether Web-based interventions for cardiovascular risk factor management reduce the risk of cardiovascular disease in older people.

    Methods: Embase, Medline, Cochrane and CINAHL were systematically searched from January 1995 to November 2014. Search terms included cardiovascular risk factors and diseases (specified), Web-based interventions (and synonyms) and randomized controlled trial. Two authors independently performed study selection, data-extraction and risk of bias assessment. In a meta-analysis, outcomes regarding treatment effects on cardiovascular risk factors (blood pressure, glycated hemoglobin A1c (HbA1C), low-density lipoprotein (LDL) cholesterol, smoking status, weight and physical inactivity) and incident cardiovascular disease were pooled with random effects models.

    Results: A total of 57 studies (N=19,862) fulfilled eligibility criteria and 47 studies contributed to the meta-analysis. A significant reduction in systolic blood pressure (mean difference -2.66 mmHg, 95% CI -3.81 to -1.52), diastolic blood pressure (mean difference -1.26 mmHg, 95% CI -1.92 to -0.60), HbA1c level (mean difference -0.13%, 95% CI -0.22 to -0.05), LDL cholesterol level (mean difference -2.18 mg/dL, 95% CI -3.96 to -0.41), weight (mean difference -1.34 kg, 95% CI -1.91 to -0.77), and an increase of physical activity (standardized mean difference 0.25, 95% CI 0.10-0.39) in the Web-based intervention group was found. The observed effects were more pronounced in studies with short (<12 months) follow-up and studies that combined the Internet application with human support (blended care). No difference in incident cardiovascular disease was found between groups (6 studies).

    Conclusions: Web-based interventions have the potential to improve the cardiovascular risk profile of older people, but the effects are modest and decline with time. Currently, there is insufficient evidence for an effect on incident cardiovascular disease. A focus on long-term effects, clinical endpoints, and strategies to increase sustainability of treatment effects is recommended for future studies.

  • 63. Bengtsson, Linus
    et al.
    Lu, Xin
    Liljeros, Fredrik
    Stockholm University, Faculty of Social Sciences, Department of Sociology. The Institute for Futures Studies, Sweden.
    Thanh, Hoang Huy
    Thorson, Anna
    Strong propensity for HIV transmission among men who have sex with men in Vietnam: behavioural data and sexual network modelling2014In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, no 1, article id e003526Article in journal (Refereed)
    Abstract [en]

    Objectives Survey data from men who have sex with men (MSM) in Asian cities indicate ongoing and drastic increases in HIV prevalence. It is unknown which behavioural factors are most important in driving these epidemics. We aimed to analyse detailed sexual behaviour data among MSM in Vietnam and to model HIV transmission using improved assumptions on sexual network structure. Setting Vietnam. Participants Internet-using men who had ever had sex (any type) with a man, aged 18years and living in Vietnam. The study was cross-sectional, population-based and performed in 2012, using online respondent-driven sampling. The Internet-based survey instrument was completed by 982 participants, of which 857 were eligible. Questions included sociodemography and retrospective sexual behaviour, including number of unprotected anal sex (UAS) acts per partner. Primary and secondary outcome measures Estimated basic reproductive number over 3months as a function of transmission risk per UAS act; frequency distributions of number of UAS partners and UAS acts during last 3months. Results 36% (CI 32% to 42%) reported UAS at least once during the last 3months. 36% (CI 32% to 41%) had ever taken an HIV test and received the result. UAS partner numbers and number of UAS acts were both highly skewed and positively correlated. Using a weighted configuration model, taking into account partner numbers, frequency of UAS and their correlations, we estimated the basic reproductive number (R0) over 3months. The results indicated rapid transmission over a wide range of values of per-act transmissibility. Conclusions Men with multiple partners had unexpectedly high UAS frequency per partner, paired with low HIV testing rates. The study highlights the importance of collecting data on frequency of UAS acts and indicates the need to rapidly scale-up HIV prevention services and testing opportunities for MSM in Vietnam.

  • 64. Benson, Rebecca
    et al.
    Glaser, Karen
    Corna, Laurie M
    Platts, Loretta G
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Di Gessa, Giorgio
    Worts, Diana
    Price, Debora
    McDonough, Peggy
    Sacker, Amanda
    Do work and family care histories predict health in older women?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 6, p. 1010-1015Article in journal (Refereed)
    Abstract [en]

    Background: Social and policy changes in the last several decades have increased women's options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women's later life health.

    Methods: We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours.

    Results: Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women's work and family care histories.

    Conclusion: Women's work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected.

  • 65.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Bäck, Karin
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental alcohol-related disorders and school performance in 16 year olds - a national cohort study2016In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 111, no 10, p. 1795-1803Article in journal (Refereed)
    Abstract [en]

    To study the links between parental alcohol-related disorders and offspring school performance and, specifically, whether associations vary by gender of parent or child and whether associations are mediated by other adverse psychosocial circumstances commonly appearing together with parental alcohol problems, such as parental mental health problems or criminal behaviour.

    Register study in a national cohort.

    Setting

    Sweden.

    740 618 individuals born in Sweden in 1990-1996.

    Parental hospital admissions for alcohol-related disorders and school performance in their offspring, in the final year of compulsory school at age 15-16, was analysed in relation to sociodemographic confounders and psychosocial covariates, using linear and logistic regressions.

    Both mothers’ and fathers’ alcohol-related hospital admissions were associated with lower z-scores of grades and national mathematic tests scores. After adjustment for parental education and sociodemographic confounders, beta-coefficients of z-scores of grades were -0.42 (95% CI -0.45, -0.39) and -0.42 (95 % CI -0.43,-0.40), and beta-coefficients of mathematic tests scores were -0.36 (95% CI -0.39, -0.33) and -0.31 (95% CI -0.33, -0.29), for mothers’ and fathers’ alcohol-related disorders, respectively. Adjusted ORs for not being eligible for secondary school were 1.99 (95% CI 1.84-2.15) and 2.04 (95% CI 1.95-2.15) for mothers’ and fathers’ alcohol-related disorders, respectively. Adjusting the analyses for psychosocial factors in the family almost eradicated the statistical effects of parental alcohol-related disorders on offspring school performance to beta-coefficients of 0.03 to -0.10 and ORs of 0.89 to 1.15. The effect of a mother's alcohol-related hospital admission on school performance was stronger in girls than in boys, whereas no gender differences were seen for a father's alcohol-related hospital admission.

    Conclusions

    In Sweden, alcohol-related disorders in both mothers and fathers are associated with lower school performance in their children at age 15-16, with most of the statistical effects being attributed to psychosocial circumstances of the family, such as parental psychiatric disorders, drug use, and criminality and receipt of social or child welfare interventions.

  • 66.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Barn till föräldrar med cancer – hur många berörs och vilka är konsekvenserna i ett livsloppsperspektiv?2016Report (Other academic)
  • 67.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Barn till separerade föräldrar: Hälsa, utbildning och sociala levnadsförhållanden i ett livsloppsperspektiv2016Report (Other academic)
    Abstract [sv]

    En halv miljon barn i Sverige har föräldrar som inte bor tillsammans. Syftet med den här studien, som utförts av CHESS på uppdrag av Socialstyrelsen, är att belysa hälsa och social situation under skolåren och tidig vuxen ålder för dessa barn. Rapporten baseras på information inhämtad från nationella register och surveyundersökningar om betyg och utbildningskarriär, arbete och inkomster, kriminalitet, psykisk ohälsa, missbruk samt kronisk sjukdom och dödlighet.

    Sammanfattningsvis visar resultaten från denna studie att barn till separerade föräldrar har en ökad risk för ohälsa, skolmisslyckande och ekonomisk utsatthet under skolåren, ungdomsåren och i ung vuxen ålder. Bland dessa barn har barn som bor enbart eller mest med en förälder det största behovet av förebyggande insatser från samhället, i synnerhet om separationen sker i tidig ålder.

  • 68.
    Berg, Lisa
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Parental death during childhood and depression in young adults – a national cohort study2016In: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610, Vol. 57, no 9, p. 1092-1098Article in journal (Refereed)
    Abstract [en]

    Background

    There are few prospective, population-based studies on childhood parental death and psychiatric disorders in adulthood, and previous findings are inconclusive. This study investigated the association between parental death from natural and external (suicides, accidents or homicides) causes before 18 years and the risk of clinical depression in young adults, in relation to age at loss and gender of both child and parent.

    Methods

    In this register-based study, a national cohort born in Sweden during 1973–1982 (n = 862,554) was followed with regard to hospital admissions and outpatient care for depression during 2006–2013. Multivariate Cox proportional hazards models were used to estimate the impact of parental death, taking sociodemographic and parental psychosocial covariates into account.

    Results

    Maternal death from natural causes was associated with a hazard ratio (HR) of outpatient care for depression of 1.19 [95% confidence interval (CI), 1.02–1.40] in men and 1.15 (1.01–1.31) in women, after adjustment for sociodemographic confounders, with similar effect sizes for paternal natural death. Death from external causes consistently had higher effect size compared with natural deaths, in particular in relation to risk of hospital admissions for depression where they were as high as HR 3.23 (2.38–4.38) for men, and 1.79 (1.30–2.47) for women after a loss of a mother. Losing a parent in preschool age, compared with losing a parent as a teenager, was associated with higher risks of both hospitalization (p = .006) and outpatient care (p = .001) for depression.

    Conclusions

    This study indicates that parental loss to death from natural causes during childhood is associated with a small increased risk of long-term consequences for psychological health. Children who lose their parents to death from external causes, that is suicides, accidents or homicides, and children losing a parent in young ages are, however, at particular risk and should be given priority in preventive interventions after parental loss.

  • 69. Bergh Johannesson, Kerstin
    et al.
    Bondjers, Kristina
    Arnberg, Filip
    Nilsson, Doris
    Ängarne-Lindberg, Teresia
    Rostila, Mikael
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Utvärdering av Barntraumateamet i Norrköping2014Report (Other academic)
  • 70.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fabian, Helena
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Sarkadi, Anna
    Salari, Raziye
    Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 2, p. 294-300Article in journal (Refereed)
    Abstract [en]

    Aim

    Joint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.

    Methods

    In this cross-sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.

    Results

    Children in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.

    Conclusion

    Joint physical custody arrangements were not associated with more psychological symptoms in children aged 3–5, but longitudinal studies are needed to account for potential preseparation differences.

  • 71.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Berlin, Marie
    Stockholm University, Faculty of Social Sciences, Department of Sociology. National Board of Health and Welfare, Sweden.
    Gustafsson, Per A.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children?2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 8, p. 769-774Article in journal (Refereed)
    Abstract [en]

    Background: In many Western countries, an increasing number of children with separated parents have joint physical custody, that is, live equally much in their parent's respective homes. In Sweden, joint physical custody is particularly common and concerns between 30% and 40% of the children with separated parents. It has been hypothesised that the frequent moves and lack of stability in parenting may be stressful for these children.

    Methods: We used data from a national classroom survey of all sixth and ninth grade students in Sweden (N=147839) to investigate the association between children's psychosomatic problems and living arrangements. Children in joint physical custody were compared with those living only or mostly with one parent and in nuclear families. We conducted sex-specific linear regression analyses for z-transformed sum scores of psychosomatic problems and adjusted for age, country of origin as well as children's satisfaction with material resources and relationships to parents. Clustering by school was accounted for by using a two-level random intercept model.

    Results: Children in joint physical custody suffered from less psychosomatic problems than those living mostly or only with one parent but reported more symptoms than those in nuclear families. Satisfaction with their material resources and parent–child relationships was associated with children's psychosomatic health but could not explain the differences between children in the different living arrangements.

    Conclusions: Children with non-cohabitant parents experience more psychosomatic problems than those in nuclear families. Those in joint physical custody do however report better psychosomatic health than children living mostly or only with one parent. Longitudinal studies with information on family factors before and after the separation are needed to inform policy of children's postseparation living arrangements.

  • 72.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Wells, Michael B.
    Köhler, Lennart
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Children with two homes: Psychological problems in relation to living arrangements in Nordic 2- to 9-year-olds2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905Article in journal (Refereed)
    Abstract [en]

    Aim: Joint physical custody, children spending equal time in each parents’ respective home after a parental divorce, is particularly common in Nordic compared with other Western countries. Older children have been shown to fare well in this practice but for young children there are few existing studies. The aim of this paper is to study psychological problems in 2- to 9-year-old Nordic children in different family forms. Methods: Total symptom score according to the Strengths and Difficulties Questionnaire as well as scores showing externalizing problems were compared among 152 children in joint physical custody, 303 in single care and 3207 in nuclear families through multiple linear regression analyses. Results: Children in single care had more psychological symptoms than those in joint physical custody (B = 1.08; 95% CI 0.48 to 1.67) and those in nuclear families had the least reported symptoms (B = −0.53; 95% CI −0.89 to −0.17). Externalizing problems were also lower in nuclear families (B = −0.28, 95% CI −0.52 to −0.04) compared with joint physical custody after adjusting for covariates. Conclusions: Young children with non-cohabiting parents suffered from more psychological problems than those in intact families. Children in joint physical custody had a lower total problem score than those in single care after adjusting for covariates. Longitudinal studies with information on family factors before the separation are needed to inform policy of young children’s post-separation living arrangements.

  • 73.
    Bergström, Malin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Fransson, Emma
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Rajmil, Luis
    Berlin, Marie
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Gustafsson, Per A.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Living in two homes-a Swedish national survey of wellbeing in 12 and 15 year olds with joint physical custody2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, article id 868Article in journal (Refereed)
    Abstract [en]

    Background The practice of joint physical custody, where children spend equal time in each parent's home after they separate, is increasing in many countries. It is particularly common in Sweden, where this custody arrangement applies to 30 per cent of children with separated parents. The aim of this study was to examine children's health-related quality of life after parental separation, by comparing children living with both parents in nuclear families to those living in joint physical custody and other forms of domestic arrangements.

    Methods Data from a national Swedish classroom study of 164,580 children aged 12 and 15-years-old were analysed by two-level linear regression modelling. Z-scores were used to equalise scales for ten dimensions of wellbeing from the KIDSCREEN-52 and the KIDSCREEN-10 Index and analysed for children in joint physical custody in comparison with children living in nuclear families and mostly or only with one parent.

    Results Living in a nuclear family was positively associated with almost all aspects of wellbeing in comparison to children with separated parents. Children in joint physical custody experienced more positive outcomes, in terms of subjective wellbeing, family life and peer relations, than children living mostly or only with one parent. For the 12-year-olds, beta coefficients for moods and emotions ranged from -0.20 to -0.33 and peer relations from -0.11 to -0.20 for children in joint physical custody and living mostly or only with one parent. The corresponding estimates for the 15-year-olds varied from -0.08 to -0.28 and from -0.03 to -0.13 on these subscales. The 15-year-olds in joint physical custody were more likely than the 12-year-olds to report similar wellbeing levels on most outcomes to the children in nuclear families.

    Conclusions Children who spent equal time living with both parents after a separation reported better wellbeing than children in predominantly single parent care. This was particularly true for the 15-year-olds, while the reported wellbeing of 12-years-olds was less satisfactory. There is a need for further studies that can account for the pre and post separation context of individual families and the wellbeing of younger age groups in joint physical custody.

  • 74.
    Berlin, Marie
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. National Board of Health and Welfare (Socialstyrelsen), Sweden.
    Mensah, Tita
    Lundgren, Frida
    Klingberg, Gunilla
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Karolinska Institutet, Sweden.
    Cederlund, Andreas
    Dental healthcare utilisation among young adults who were in societal out-of-home care as children: A Swedish National Cohort Study2018In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 27, no 4, p. 325-336Article in journal (Refereed)
    Abstract [en]

    We used Swedish national registers to analyse dental health care among young adults with childhood experience of out-of-home care (OHC), in Cox regression analyses. All 1.7 million Swedish residents born in 1980-1994 were included, of whom 4% had been in OHC. The population was followed up in the Dental Health Register from age 20 to 29, during the period 2009-2014. We found that persons with short or long OHC experience made emergency dental care visits more often than their majority-population peers: 17-23% versus 9-10%, (adjusted Hazard ratios [HR:s] 1.60-2.02); they more often had tooth extractions, 9-12% versus 3% (HR:s 2.33-3.03); but less regularly visited a dentist for planned check-ups, 61-77% versus 80-87% (HR:s 0.76-0.78). Since dental health in young adulthood reflects dental health and dental care in childhood, the findings of this study call for improved preventive dental health care for children in OHC.

  • 75. Bernard, H.
    et al.
    Faber, M.
    Wilking, H.
    Haller, S.
    Höhle, Michael
    Robert Koch Institute, Germany.
    Schielke, A.
    Ducomble, T.
    Siffczyk, C.
    Merbecks, S. S.
    Fricke, G.
    Hamouda, O.
    Stark, K.
    Werber, D.
    Large multistate outbreak of norovirus gastroenteritis associated with frozen strawberries, East Germany, 20122014In: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 19, no 8, article id pii=20719Article in journal (Refereed)
    Abstract [en]

    From 20 September through 5 October 2012, the largest recorded food-borne outbreak in Germany occurred. Norovirus was identified as the causative agent. We conducted four analytical epidemiological studies, two case–control studies and two surveys (in total 150 cases) in secondary schools in three different federal states. Overall, 390 institutions in five federal states reported nearly 11,000 cases of gastroenteritis. They were predominantly schools and childcare facilities and were supplied almost exclusively by one large catering company. The analytical epidemiological studies consistently identified dishes containing strawberries as the most likely vehicle, with estimated odds ratios ranging from 2.6 to 45.4. The dishes had been prepared in different regional kitchens of the catering company and were served in the schools two days before the peaks of the respective outbreaks. All affected institutions had received strawberries of one lot, imported frozen from China. The outbreak vehicle was identified within a week, which led to a timely recall and prevented more than half of the lot from reaching the consumer. This outbreak exemplifies the risk of large outbreaks in the era of global food trade. It underlines the importance of timely surveillance and epidemiological outbreak investigations for food safety.

  • 76. Bernard, Helen
    et al.
    Werber, Dirk
    Höhle, Michael
    Stockholm University, Faculty of Science, Department of Mathematics. Robert Koch Institute, Germany.
    Estimating the under-reporting of norovirus illness in Germany utilizing enhanced awareness of diarrhoea during a large outbreak of Shiga toxin-producing E. coli O104:H4 in 2011 - a time series analysis2014In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 14, article id 116Article in journal (Refereed)
    Abstract [en]

    Background: Laboratory- confirmed norovirus illness is reportable in Germany since 2001. Reported case numbers are known to be undercounts, and a valid estimate of the actual incidence in Germany does not exist. An increase of reported norovirus illness was observed simultaneously to a large outbreak of Shiga toxin-producing E. coli O104: H4 in Germany in 2011 - likely due to enhanced (but not complete) awareness of diarrhoea at that time. We aimed at estimating age- and sex-specific factors of that excess, which should be interpretable as (minimal) under-reporting factors of norovirus illness in Germany. Methods: We used national reporting data on laboratory-confirmed norovirus illness in Germany from calendar week 31 in 2003 through calendar week 30 in 2012. A negative binomial time series regression model was used to describe the weekly counts in 8.2 age- sex strata while adjusting for secular trend and seasonality. Overall as well as age- and sex- specific factors for the excess were estimated by including additional terms (either an O104: H4 outbreak period indicator or a triple interaction term between outbreak period, age and sex) in the model. Results: We estimated the overall under- reporting factor to be 1.76 (95% Cl 1.28- 2.41) for the first three weeks of the outbreak before the outbreak vehicle was publicly communicated. Highest under-reporting factors were here estimated for 20- 29 year-old males (2.88, 95% Cl 2.01- 4.11) and females (2.67, 95% Cl 1.87- 3.79). Under-reporting was substantially lower in persons aged < 10 years and 70 years or older. Conclusions: These are the first estimates of (minimal) under- reporting factors for norovirus illness in Germany. They provide a starting point for a more detailed investigation of the relationship between actual incidence and reporting incidence of norovirus illness in Germany.

  • 77. Bernehäll Claesson, Inger
    et al.
    Brodin, Jane
    Stockholm University, Faculty of Social Sciences, Department of Child and Youth Studies.
    What families with children with brittle bones want to tell2002In: Child: Care, Health and Development, Vol. 28, no 4, p. 309-315Article in journal (Refereed)
    Abstract [en]

    Interviews with parents of children with brittle bones and questionnaires answered by 30 families about everyday life.

  • 78. Bernhard-Oettel, C.
    et al.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    The temporaries, theself-employed and the permanent staff: A Swedish study comparing work characteristics and individual well-being over time2013Conference paper (Refereed)
  • 79.
    Beronius, Anna
    et al.
    Stockholm University, Faculty of Science, Department of Environmental Science and Analytical Chemistry.
    Vandenberg, Laura N.
    Using systematic reviews for hazard and risk assessment of endocrine disrupting chemicals2016In: Reviews in endocrine and metabolic disorders (Print), ISSN 1389-9155, E-ISSN 1573-2606, Vol. 16, no 4, p. 273-287Article, review/survey (Refereed)
    Abstract [en]

    The possibility that endocrine disrupting chemicals (EDCs) in our environment contribute to hormonally related effects and diseases observed in human and wildlife populations has caused concern among decision makers and researchers alike. EDCs challenge principles traditionally applied in chemical risk assessment and the identification and assessment of these compounds has been a much debated topic during the last decade. State of the science reports and risk assessments of potential EDCs have been criticized for not using systematic and transparent approaches in the evaluation of evidence. In the fields of medicine and health care, systematic review methodologies have been developed and used to enable objectivity and transparency in the evaluation of scientific evidence for decision making. Lately, such approaches have also been promoted for use in the environmental health sciences and risk assessment of chemicals. Systematic review approaches could provide a tool for improving the evaluation of evidence for decision making regarding EDCs, e.g. by enabling systematic and transparent use of academic research data in this process. In this review we discuss the advantages and challenges of applying systematic review methodology in the identification and assessment of EDCs.

  • 80. Berthelsen, Hanne
    et al.
    Muhonen, Tuija
    Toivanen, Susanna
    Mälardalens högskola, Sverige.
    Vad händer med arbetsmiljön när man inför aktivitetsbaserade kontor inom akademin?2017In: Arbetsmarknad & Arbetsliv, ISSN 1400-9692, Vol. 23, no 3, p. 9-23Article in journal (Refereed)
    Abstract [sv]

    Aktivitetsbaserade kontor är fortfarande ovanliga för forskare och lärare inom akademin, men nu verkar flera lärosäten vara igång att införa den här typen av arbetsplatser. Det finns begränsat med kunskap om vad som händer vid flyttprocesser från egna rum till aktivitetsbaserade kontor i akademin och hur personalen upplever arbetsmiljön i denna typ av kontorsmiljöer. I den här artikeln redovisas resultat från en enkätundersökning före och efter flytt till aktivitetsbaserade kontor på en svensk högskola.

  • 81. Bharadwaj, Prashant
    et al.
    Lundborg, Petter
    Rooth, Dan-Olof
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Birth Weight in the Long Run2018In: The Journal of human resources, ISSN 0022-166X, E-ISSN 1548-8004, Vol. 53, no 1, p. 189-231Article in journal (Refereed)
    Abstract [en]

    We study the effect of birth weight on long-run outcomes using data on Swedish twins born between 1926 and 1958 linked to administrative records spanning entire life-time labor market histories. We find that birth weight positively affects permanent income and income across large parts of the lifecycle. The timing of the birth weight–income relationship is in line with the role of birth weight in determining takeup of sickness benefits and morbidity. The effect of birth weight on labor market outcomes even for cohorts born 30 years apart are similar; for short run health outcomes, birth weight plays a decreasing role over time.

  • 82. Bijlsma, Maarten J.
    et al.
    Tarkiainen, Lasse
    Myrskylä, Mikko
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Max Planck Institute for Demographic Research, Germany: University of Helsinki,, Finland.
    Unemployment and subsequent depression: A mediation analysis using the parametric G-formula2017In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 194, p. 142-150Article in journal (Refereed)
    Abstract [en]

    The effects of unemployment on depression are difficult to establish because of confounding and limited understanding of the mechanisms at the population level. In particular, due to longitudinal interdependencies between exposures, mediators and outcomes, intermediate confounding is an obstacle for mediation analyses. Using longitudinal Finnish register data on socio-economic characteristics and medication purchases, we extracted individuals who entered the labor market between ages 16 and 25 in the period 1996 to 2001 and followed them until the year 2007 (n = 42,172). With the parametric G-formula we estimated the population averaged effect on first antidepressant purchase of a simulated intervention which set all unemployed person years to employed. In the data, 74% of person-years were employed and 8% unemployed, the rest belonging to studying or other status. In the intervention scenario, employment rose to 85% and the hazard of first antidepressant purchase decreased by 7.6%. Of this reduction 61% was mediated, operating primarily through changes in income and household status, while mediation through other health conditions was negligible. These effects were negligible for women and particularly prominent among less educated men. By taking complex interdependencies into account in a framework of observed repeated measures data, we found that eradicating unemployment raises income levels, promotes family formation, and thereby reduces antidepressant consumption at the population-level.

  • 83.
    Björkenstam, Charlotte
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. University of California, USA; Karolinska Institutet, Sweden .
    Andersson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Dalman, Christina
    Cochran, Susan
    Kosidou, Kyriaki
    Suicide in married couples in Sweden: Is the risk greater in same-sex couples?2016In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 31, no 7, p. 685-690Article in journal (Refereed)
    Abstract [en]

    Minority sexual orientation is a predictor of suicide ideation and attempts, though its association with suicide mortality is less clear. We capitalize on Sweden's extensively linked databases, to investigate whether, among married individuals, same-sex marriage is associated with suicide. Using a population-based register design, we analyzed suicide risk among same-sex married women and men (n = 6456), as compared to different-sex married women and men (n = 1181723) in Sweden. We selected all newly partnered or married individuals in the intervening time between 1/1/1996 and 12/31/2009 and followed them with regard to suicide until 12/31/2011. Multivariate Poisson regression was used to calculate adjusted incidence risk ratios (IRR) with 95 % confidence intervals (CI). The risk of suicide was higher among same-sex married individuals as compared to different-sex married individuals (IRR 2.7, 95 % CI 1.5-4.8), after adjustment for time at risk and socioeconomic confounding. Sex-stratified analyses showed a tentatively elevated risk for same-sex married women (IRR 2.5, 95 % CI 0.8-7.7) as compared to different-sex married women. Among same-sex married men the suicide risk was nearly three-fold greater as compared to different-sex married (IRR 2.895 % CI 1.5-5.5). This holds true also after adjustment for HIV status. Even in a country with a comparatively tolerant climate regarding homosexuality such as Sweden, same-sex married individuals evidence a higher risk for suicide than other married individuals.

  • 84.
    Björkenstam, Charlotte
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Karolinska Institutet, Sweden; University of California, USA.
    Kosidou, Kyriaki
    Björkenstam, Emma
    Dalman, Christina
    Andersson, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Cochran, Susan
    Self-reported suicide ideation and attempts, and medical care for intentional self-harm in lesbians, gays and bisexuals in Sweden2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 9, p. 895-901Article in journal (Refereed)
    Abstract [en]

    Background Minority sexual orientation is a robust risk indicator for self-reported suicidal ideation and attempts. However, little is known about patterns of medical care for intentional self-harm in this vulnerable population. We investigate sexual orientation-related differences in self-reported lifetime suicide symptoms and medical care for intentional self-harm between 1969 and 2010, including age at initial treatment and recurrence. Methods We used data from the Stockholm Public Health Cohort, a population-based sample of 874 lesbians/gays, 841 bisexuals and 67980 heterosexuals, whose self-administered surveys have been linked to nationwide registers. Estimates of risk for medical care were calculated as incidence rate ratios (IRR) with 95% CIs. Results Both suicidal ideation and attempts were more commonly reported by lesbian/gay and bisexual (LGB) individuals. Adjusting for risk-time and confounding, lesbians (IRR 3.8, 95% CI 2.7 to 5.4) and bisexual women (IRR 5.4, 95% CI 4.4 to 6.6) experienced elevated risk for medical care for intentional self-harm, as compared to heterosexual women. Gay men evidenced higher risk (IRR 2.1, 95% CI 1.3 to 3.4) as compared to heterosexual men. Recurrent medical care was more frequent in LGB individuals, especially in bisexual women and gay men. Lesbian and bisexual women were also younger than heterosexual women when they first received medical care for intentional self-harm. Conclusions Positive histories of suicidal ideation, attempts and medical care for intentional self-harm, including higher levels of recurrence, are more prevalent among LGB individuals in contrast to heterosexuals. Lesbian/bisexual women evidence an earlier age of onset of treatment. Tailored prevention efforts are urgently needed.

  • 85. Björkenstam, Emma
    et al.
    Cheng, Siwei
    Burström, Bo
    Pebley, Anne R.
    Björkenstam, Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Sociology. University of California, USA; Karolinska Institutet, Sweden.
    Kosidou, Kyriaki
    Association between income trajectories in childhood and psychiatric disorder: a Swedish population-based study2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 7, p. 648-654Article in journal (Refereed)
    Abstract [en]

    Background Childhood family income variation is an understudied aspect of households' economic context that may have distinct consequences for children. We identified trajectories of childhood family income over a 12-year period, and examined associations between these trajectories and later psychiatric disorders, among individuals born in Sweden between 1987 and 1991 (n=534 294).

    Methods We used annual income data between the ages of 3-14 years and identified 5 trajectories (2 high-income upward, 1 downward and 2 low-income upward trajectories). Psychiatric disorders in the follow-up period after age 15 were defined from International Classification of Disease (ICD)-codes in a nationwide patient register. Multiadjusted risks for all psychiatric disorders, as well as for specific psychiatric diagnoses, were calculated as HRs with 95% CIs.

    Results Of the 5 identified income trajectories, the constant low and the downward trajectories were particularly associated with later psychiatric disorder. Children with these trajectories had increased risks for psychiatric disorder, including mood, anxiety, psychotic disorders and attention deficit/hyperactivity disorder. The association remained, even after adjusting for important variables including parental psychiatric disorder. In contrast, the relationship was reversed for eating disorders, for which children in higher income trajectories had elevated risks.

    Conclusions Findings show that children growing up in a household characterised by low or decreasing family income have an increased risk for psychiatric disorder. Continued work is needed to reduce socioeconomic inequalities in psychiatric disorders. Policies and interventions for psychiatric disorders should consider the socioeconomic background of the family as an important risk or protective factor.

  • 86. Björkenstam, Emma
    et al.
    Dalman, Christina
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Ringbäck Weitoft, Gunilla
    Walder, Deborah J.
    Burström, Bo
    Childhood household dysfunction, school performance and psychiatric care utilisation in young adults: a register study of 96 399 individuals in Stockholm County2016In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 70, no 5, p. 473-480Article in journal (Refereed)
    Abstract [en]

    Background Exposure to childhood household dysfunction increases the risk of psychiatric morbidity. Although school performance also has been linked with psychiatric morbidity, limited research has considered school performance as a mediating factor. To address this gap in the literature, the current register study examined whether school performance mediates the association between childhood household dysfunction (experienced between birth and age 14 years) and psychiatric care utilisation in young adulthood.

    Methods We used a Swedish cohort of 96 399 individuals born during 1987–1991. Indicators of childhood household dysfunction were familial death, parental substance abuse and psychiatric morbidity, parental somatic disease, parental criminality, parental separation/single-parent household, public assistance recipiency and residential instability. Final school grades from the 9th year of compulsory school were used to create five categories. Estimates of risk of psychiatric care utilisation (measured as inpatient, outpatient and primary care) after the age of 18 years were calculated as HRs with 95% CIs. Mediation was tested with the bootstrap approach.

    Results Cumulative exposure to childhood household dysfunction was positively associated with psychiatric care utilisation. Specifically, individuals exposed to three or more indicators with incomplete school grades had the highest risk (HR=3.7 (95% CI 3.3 to 4.1) after adjusting for demographics), compared to individuals exposed to no indicators with highest grades. School performance was found to mediate the relationship.

    Conclusions Our findings suggest that future efforts to prevent or mitigate the negative effects of childhood household dysfunction on psychiatric morbidity may benefit from integration of strategies that improve school performance among vulnerable youth.

  • 87. Björkenstam, Emma
    et al.
    Ekselius, Lisa
    Burström, Bo
    Kosidou, Kyriaki
    Björkenstam, Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Sociology. Karolinska Institutet, Sweden; University of California, USA.
    Association between childhood adversity and a diagnosis of personality disorder in young adulthood: a cohort study of 107,287 individuals in Stockholm County2017In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 32, no 8, p. 721-731Article in journal (Refereed)
    Abstract [en]

    Childhood adversity (CA) may increase the risk for later developing of personality disorder (PD). However, less is known about the association between cumulative CA and PD, and the role of childhood psychopathology and school performance. The current study examined the relationship between a range of CAs and a diagnosis of PD in young adulthood, and the roles of childhood psychopathology and school performance in this relationship. All individuals born in Stockholm County 1987-1991 (n = 107,287) constituted our cohort. Seven CAs were measured between birth and age 14: familial death, parental criminality, parental substance abuse and psychiatric morbidity, parental separation and/or single-parent household, household public assistance and residential instability. Individuals were followed from their 18th birthday until they were diagnosed with PD or until end of follow-up (December 31st 2011). Adjusted estimates of risk of PD were calculated as hazard ratios (HR) with 95% confidence intervals (CI). Associations were observed between cumulative CA and PD. During the follow-up 770 individuals (0.7%) were diagnosed with PD. Individuals exposed to 3+ CAs had the highest risks of being diagnosed with PD (HR 3.0, 95% CI 2.4-3.7). Childhood psychopathology and low school grades further increased the risk of PD among individuals exposed to CA. Cumulative CA is strongly associated with a diagnosis of PD in young adulthood. Our findings indicate that special attention should be given in schools and health services to children exposed to adversities to prevent decline in school performance, and to detect vulnerable individuals that may be on negative life-course trajectories.

  • 88. Björkenstam, Emma
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Björkenstam, Charlotte
    Kosidou, Kyriaki
    Association of Cumulative Childhood Adversity and Adolescent Violent Offending With Suicide in Early Adulthood2018In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 75, no 2, p. 185-193Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Childhood adversity (CA) is associated with an increased risk of suicide in young adulthood that might be explained by maladaptive trajectories during adolescence. Although adolescent violent offending is linked with suicide, little is known about its role in the association between CA and suicide. OBJECTIVE To examine whether adolescent violent offending mediates the association between CA and suicide in early adulthood. DESIGN, SETTING, AND PARTICIPANTS This population-based, longitudinal cohort study with a follow-up time spanning 5 to 9 years included 476 103 individuals born in Sweden between 1984 and 1988. The study population was prospectively followed up from 20 years of age until December 31, 2013, with respect to suicide. Data analysis was performed from January 1, 1984, to December 31, 2013. EXPOSURES Register-based CAs included parental death, parental substance abuse and psychiatric disorder, parental criminal offending, parental separation, public assistance recipiency, child welfare intervention, and residential instability. Adolescent violent offending was defined as being convicted of a violent crime between the ages of 15 and 19 years. MAIN OUTCOMES AND MEASURES Estimates of risk of suicide after 20 years of age (from 2004 if born in 1984 and from 2008 if born in 1988) until the end of 2013 were calculated as incidence rate ratios (IRRs) with 95% CIs using Poisson regression analysis. Adjustments were made for demographics and psychiatric disorder. In addition, binary mediation analysis with logistic regression was used. RESULTS A total of 476 103 individuals (231 699 [48.7%] female) were included in the study. Those with a conviction for violent offending had been exposed to all CAs to a greater extent than those with no violent offending. Cumulative CA was associated with risk of suicide in nonconvicted (adjusted IRR, 2.4; 95% CI, 1.5-3.9) and convicted youths, who had a higher risk of suicide (adjusted IRR, 8.5; 95% CI, 4.6-15.7). Adolescent violent offending partly mediated the association between CA and suicide. CONCLUSIONS AND RELEVANCE Individuals with a history of CA who also engage in violent offending in adolescence have a high risk of suicide. Interventions to prevent externalizing behavior during childhood and increased support to youths with delinquent behavior may have the potential to prevent suicide related to CA.

  • 89. Björkenstam, Emma
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Adverse childhood experiences and disability pension in early midlife: results from a Swedish National Cohort Study2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 3, p. 472-477Article in journal (Refereed)
    Abstract [en]

    Background: Few studies have examined the association between adverse childhood experiences (ACEs) and disability pension (DP). The current study aimed to investigate the relationship between different ACEs, cumulative ACEs, and DP, and the mediating role of school performance. Methods: We used a Swedish cohort of 522 880 individuals born between 1973 and 1978. ACEs included parental death, parental substance abuse and psychiatric disorder, substantial parental criminality, household public assistance, parental DP and child welfare intervention. Estimates of risk of DP in 2008 were calculated as odds ratios (OR) with 95% confidence intervals (CIs). Results: A total of 2.3% (3.0% females, 1.7% males) received DP in 2008. All studied ACEs increased the odds for DP, particularly child welfare intervention and household public assistance. Cumulative ACEs increased the odds of DP in a graded manner. Females exposed to 4+ ACEs had a 4-fold odds (OR: 4.0, 95% CI 3.5-4.5) and males a 7-fold odds (OR: 7.1, 95% CI: 6.2-8.1). School performance mediated the ACEs-DP association. Conclusion: This study provides evidence that ACEs is associated with increased odds of DP, particularly when accumulated. The effects of ACEs should be taken into account when considering the determinants of DP, and when identifying high-risk populations.

  • 90. Björkenstam, Emma
    et al.
    Vinnerljung, Bo
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Karolinska Institutet, Sweden.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Impact of childhood adversities on depression in early adulthood: A longitudinal cohort study of 478,141 individuals in Sweden2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 223, p. 95-100Article in journal (Refereed)
    Abstract [en]

    Objective: Although the relationship between childhood adversity (CA) and depression is widely accepted, there is little information on what proportion of depression is attributable to CA. Method: We used a Swedish cohort of 478,141 individuals born in 1984-1988 in Sweden. Register-based CA indicators included parental death, parental substance abuse and psychiatric morbidity, parental criminality, parental separation, public assistance recipiency, child welfare intervention, and residential instability. Estimates of risk of depression, measured as retrieval of prescribed antidepressants and/or psychiatric care with a clinical diagnosis of depression, between 2006 and 2012 were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI), using a Cox regression analysis. Results: All CAs predicted depression in early adulthood. Furthermore, the predictive association between the CA indicators and depression was graded, with highest HRs observed for 4+ CAs (HR: 3.05 (95% CI 2.83-3.29)) for a clinical diagnosis for depression and HR: 1.32 (95% CI 1.25-1.41) for antidepressant medication after adjustments were made for important confounding factors. Of the studied CAs, child welfare intervention entailed highest HR for depression. Conclusion: Regardless of causality issues, children and youth with a history of multiple CA should be regarded as a high-risk group for depression by professionals in social, and health service's that come into contact with this group.

  • 91. Blom, Victoria
    et al.
    Richter, Anne
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Hallsten, Lennart
    Svedberg, Pia
    The associations between job insecurity, depressive symptoms and burnout: The role of performance-based self-esteem2018In: Economic and Industrial Democracy, ISSN 0143-831X, E-ISSN 1461-7099, Vol. 39, no 1, p. 48-63Article in journal (Refereed)
    Abstract [en]

    Despite agreement on the negative effects of job insecurity, more knowledge needs to be generated on the health effects in terms of burnout and depressive symptoms and for whom job insecurity has these negative effects. The present study aims to investigate the associations between job insecurity and burnout and depressive symptoms respectively, by studying the moderation influences of performance-based self-esteem (PBSE), a form of contingent self-esteem. A population-based sample with 4145 twins was used. The results showed that job insecurity was significantly associated with both burnout and depressive symptoms, and that PBSE acted as a moderator, so that the associations were stronger for individuals with high PBSE than for individuals with low PBSE. The study contributes by including a personality characteristic to gain more knowledge about the mechanisms of job insecurity on mental ill-health, and by illustrating that job insecurity has an impact on severe health outcomes in terms of burnout and depressive symptoms.

  • 92.
    Blomqvist, Jan
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Av egen kraft - med andras stöd2013In: Hjälpande möten i vård och omvärld: brukare, praktiker och forskare reflekterar / [ed] Ingemar Ljungqvist, Håkan Jenner, Stockholm: Liber, 2013, p. 182-210Chapter in book (Other academic)
  • 93.
    Blomqvist, Jan
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Dogmer som dödar: Vägval för svensk narkotikapolitik2017In: Dogmer som dödar: Vägval för svensk narkotikapolitik / [ed] Niklas Eklund, Mikaela Hildebrand, Stockholm: Verbal , 2017, p. 291-311Chapter in book (Other academic)
  • 94. Blomqvist, Jan
    et al.
    Raitasalo, Kirsimarja
    Koski-Jännes, Anja
    Klingemann, Justyna
    Melberg, Hans Olov
    Schreckenberg, Dirk
    Peschel, Christine
    Popular Images of Adiction in five European Countries2014Report (Other academic)
  • 95.
    Blomqvist, Sandra
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Alexanderson, Kristina
    Vahtera, Jussi
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Downsizing and purchases of psychotropic drugs: A longitudinal study of stayers, changers and unemployed2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 8, article id e0203433Article in journal (Refereed)
    Abstract [en]

    Background The evidence is insufficient regarding the association between organizational downsizing and employee mental health. Our aim was to analyze trajectories of prescribed sedatives and anxiolytics with a sufficiently long follow-up time to capture anticipation, implementation and adaption to a downsizing event among stayers, changers and those who become unemployed compared to unexposed employees. Method Swedish residents aged 20-54 years in 2007, with stable employment between 2004 and 2007, were followed between 2005 and 2013 (n = 2,305,795). Employment at a workplace with staff reductions >= 18% between two subsequent years in 2007-2011 (n = 915,461) indicated exposure to, and timing of, downsizing. The unexposed (n = 1,390,334) were randomized into four corresponding sub-cohorts. With generalized estimating equations, we calculated the odds ratios (OR) of purchasing prescribed anxiolytics or sedatives within nine 12-month periods, from four years before to four years after downsizing. In order to investigate whether the groups changed their probability of purchases over time, odds ratios (OR) and their 95% confidence intervals (95% CI) were calculated contrasting the prevalence of purchases during the first and the last 12-month period within four time periods for each exposure group. Results The odds of purchasing anxiolytics increased more for stayers (OR 1.03, 95% CI 1.01-1.06) and unemployed (OR 1.08, 95% CI 1.03-1.14) compared to unexposed before downsizing, and purchases continued to increase after downsizing for stayers. Among those without previous sickness absence, stayers increased their purchases of anxiolytics from the year before the event up to four years after the event. Trajectories for sedatives were similar but less pronounced. Conclusion This study indicates that being exposed to downsizing is associated with increased use of sedatives and anxiolytics, especially before the event, if the employee stays in the organization or becomes unemployed.

  • 96.
    Bodin Danielsson, Christina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lean i arbetslivet: Lean inom kontorsdesign2013In: Lean i arbetslivet / [ed] Per Sederblad, Stockholm: Liber, 2013, 1, p. 162-189Chapter in book (Other academic)
  • 97. Bodin, Maja
    et al.
    Stern, Jenny
    Käll, Lisa Folkmarson
    Centre for Gender Research, Humanistiskt centrum, Uppsala, Sweden; Centre for Dementia Research, Linköping University, Linköping, Sweden.
    Tydén, Tanja
    Larsson, Margareta
    Coherence of pregnancy planning within couples expecting a child2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 10, p. 973-978Article in journal (Refereed)
  • 98.
    Bognar, Greg
    Stockholm University, Faculty of Humanities, Department of Philosophy. La Trobe University, Australia.
    Is disability mere difference?2016In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 42, no 1, p. 46-49Article in journal (Refereed)
  • 99. Bohman, H
    et al.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Päären, A
    Jonsson, U
    Somatic symptoms in adolescence as a predictor of in-patient care for mental disorders in adulthood2016In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 1Article in journal (Other academic)
    Abstract [en]

    Background

    Somatic symptoms such as headache, abdominal pain and dizziness, are common among young people and often associated with poor everyday functioning and concurrent mental disorders. Yet, relatively few studies have examined the long-term consequences of such symptoms. The aim of the study was to investigate if somatic symptoms in adolescence predict adulthood hospital based care for mental disorders.

    Methods

    The total school population of 16-17-year olds, in the city of Uppsala, Sweden, was screened for depression in 1991-1993. Adolescents with positive screening and the same number of healthy controls took part in a semi-structured diagnostic interview of mental disorders. In addition, 21 different self-rated functional somatic symptoms were assessed. The participants were followed up in the national patients register about 20 years later (n = 337). The associations between somatic symptoms in adolescence and in-patient care and out-patient hospital based mental health care in adulthood were analysed using binary logistic regression analysis.

    Results

    Adolescents with somatic symptoms had an excess risk of later psychiatric hospital based health care. The presence of multiple somatic symptoms (≥5) in adolescence was associated with psychiatric hospital based care in adulthood also when controlling for depression and anxiety in adolescence as well as sex and potential psychosocial confounders (OR 3.29, p = 0.046). The presence of just any somatic symptom (≥1) in adolescence predicted later hospital based mental health care for mood disorders (OR 8.49, p = 0.041) whereas adolescent depression, anxiety and sex did not, when mutually adjusted for.

    Conclusions

    Somatic symptoms in adolescence are a strong independent predictor of severe mental health problems in adulthood. The link between adolescent somatic symptoms and adult mood disorders are particularly strong even when somatic symptoms are compared head to head with concurrent depression and anxiety.

  • 100. Bohman, Hannes
    et al.
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Cleland, Neil
    Lundberg, Mathias
    Päären, Aivar
    Jonsson, Ulf
    Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: a long-term community-based follow-up study2018In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 12, article id 42Article in journal (Refereed)
    Abstract [en]

    Background: Somatic symptoms are common and costly for society and correlate with suffering and low functioning. Nevertheless, little is known about the long-term implications of somatic symptoms. The objective of this study was to assess if somatic symptoms in adolescents with depression and in their matched controls predict severe mental illness in adulthood by investigating the use of hospital-based care consequent to different mental disorders. Methods: The entire school population of 16-17-year-olds in the city of Uppsala, Sweden, was screened for depression in 1991-1993 (n = 2300). Adolescents with positive screenings (n = 307) and matched non-depressed controls (n = 302) participated in a semi-structured diagnostic interview for mental disorders. In addition, 21 different self-rated somatic symptoms were assessed. The adolescents with depression and the matched non-depressed controls were engaged in follow-up through the National Patient Register 17-19 years after the baseline study (n = 375). The outcome measures covered hospital-based mental health care for different mental disorders according to ICD-10 criteria between the participants' ages of 18 and 35 years. Results: Somatic symptoms were associated with an increased risk of later hospital-based mental health care in general in a dose-response relationship when adjusting for sex, adolescent depression, and adolescent anxiety (1 symptom: OR = 1.63, CI 0.55-4.85; 2-4 symptoms: OR = 2.77, 95% CI 1.04-7.39; >= 5 symptoms: OR = 5.75, 95% CI 1.98-16.72). With regards to specific diagnoses, somatic symptoms predicted hospital-based care for mood disorders when adjusting for sex, adolescent depression, and adolescent anxiety (p<0.05). In adolescents with depression, somatic symptoms predicted later hospital-based mental health care in a dose-response relationship (p<0.01). In adolescents without depression, reporting at least one somatic symptom predicted later hospital-based mental health care (p<0.05). Conclusions: Somatic symptoms in adolescence predicted severe adult mental illness as measured by hospital-based care also when controlled for important confounders. The results suggest that adolescents with somatic symptoms need early treatment and extended follow-up to treat these specific symptoms, regardless of co-occurring depression and anxiety.

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