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Lallukka, T., Mekuria, G. B., Nummi, T., Virtanen, P., Virtanen, M. & Hammarström, A. (2019). Co-occurrence of depressive, anxiety, and somatic symptoms: trajectories from adolescence to midlife using group-based joint trajectory analysis. BMC Psychiatry, 19, Article ID 236.
Open this publication in new window or tab >>Co-occurrence of depressive, anxiety, and somatic symptoms: trajectories from adolescence to midlife using group-based joint trajectory analysis
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2019 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 19, article id 236Article in journal (Refereed) Published
Abstract [en]

Background: Co-occurrence of mental and somatic symptoms is common, and recent longitudinal studies have identified single trajectories of these symptoms, but it is poorly known whether the symptom trajectories can also co-occur and change across the lifespan. We aimed to examine co-occurring symptoms and their joint trajectories from adolescence to midlife.

Methods: Longitudinal data were derived from Northern Sweden, where 506 girls and 577 boys aged 16years participated at baseline in 1981 (99.7% of those initially invited), and have been followed up in four waves until the age of 43. Survey data were collected about depressive, anxiety, and somatic symptoms. Potential joint development of this three-component symptom set was examined with multiple response trajectory analysis, a method that has not been previously used to study co-occurrence of these symptoms.

Results: We identified a five trajectory solution as the best: very low (19%), low (31%), high (22%), late sharply increasing (16%) and a very high increasing (12%). In the late sharply increasing and very high increasing groups the scores tended to increase with age, while in the other groups the levels were more stable. Overall, the results indicated that depressive, anxiety, and somatic symptoms co-exist from adolescence to midlife.

Conclusions: The multiple response trajectory analysis confirmed high stability in the co-occurrence of depressive, anxiety, and somatic symptoms from adolescence to midlife. Clinicians should consider these findings to detect symptoms in their earliest phase in order to prevent the development of co-occurring high levels of symptoms.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Mental health, Epidemiology, Adolescents, Adults
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162673 (URN)10.1186/s12888-019-2203-7 (DOI)000478669000001 ()31370894 (PubMedID)
Available from: 2019-09-02 Created: 2019-09-02 Last updated: 2019-09-02Bibliographically approved
Linander, I., Goicolea, I., Alm, E., Hammarström, A. & Harryson, L. (2019). (Un)safe spaces, affective labour and perceived health among people with trans experiences living in Sweden. Culture, Health and Sexuality, 21(8), 914-928
Open this publication in new window or tab >>(Un)safe spaces, affective labour and perceived health among people with trans experiences living in Sweden
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2019 (English)In: Culture, Health and Sexuality, ISSN 1369-1058, E-ISSN 1464-5351, Vol. 21, no 8, p. 914-928Article in journal (Refereed) Published
Abstract [en]

Lack of safe space has been connected to ill health among people with trans experiences. This study analyses trans people’s experiences of being in public, semi-public and community spaces using the analytical concept of safety/unsafety in relation to perceived health. The analytic framework draws on the concepts of cisgenderism, orientation, lines and comfort. The material analysed consisted of 18 individual interviews with people with trans experiences, which were analysed using constructivist thematic analysis. The analysis resulted in the identification of three themes: straightening devices creating limited living space, orienting oneself in (cis)gendered spaces and creating safer (?) community spaces for healing. Experiences of unsafety ranged from incidents and fear of different kinds of violence in public and semi-public spaces to the lack of a transpolitically informed agenda in, for example, feminist spaces. Safer spaces helped participants to feel a sense of belonging, to share their experiences and to heal. Experiences of unsafety and discomfort are important as they will help us to understand the health situations of people with trans experiences. It is important to facilitate the creation of safer spaces to improve the health of members of this group.

Place, publisher, year, edition, pages
Routledge, 2019
Keywords
Sweden, Transgender, affective labour, safety, space
National Category
Public Health, Global Health, Social Medicine and Epidemiology Gender Studies
Identifiers
urn:nbn:se:umu:diva-152679 (URN)10.1080/13691058.2018.1527038 (DOI)000473015600004 ()30601097 (PubMedID)
Funder
Swedish Research Council, 344-2011-5478
Note

Originally included in thesis in manuscript form

Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2019-09-06Bibliographically approved
Eriksson, M., Ghazinour, M. & Hammarström, A. (2018). Different uses of Bronfenbrenner's ecological theory in public mental health research: what is their value for guiding public mental health policy and practice?. Social Theory & Health, 16(4), 414-433
Open this publication in new window or tab >>Different uses of Bronfenbrenner's ecological theory in public mental health research: what is their value for guiding public mental health policy and practice?
2018 (English)In: Social Theory & Health, ISSN 1477-8211, E-ISSN 1477-822X, Vol. 16, no 4, p. 414-433Article in journal (Refereed) Published
Abstract [en]

Bronfenbrenner’s ecological theory is appealing as a conceptual tool for guiding public mental health interventions. However, his theory underwent significant changes since its first inception during the late 1970s until his death in 2005, due to which the implications that can be drawn might differ depending on what concepts (i.e. early or later) of the theory is utilized. The aim of this paper was to examine how different concepts of Bronfenbrenner’s theory have been utilized in (public) mental health research, and to analyse the value of these different uses for guiding public mental health policy and practice. A systematic search for articles that have utilized concepts of Bronfenbrenner’s theory within the field of mental health resulted in a review of 16 published papers. We found that one set of papers (N = 10) used the early concepts of ecological systems without investigating interactions between these systems, while another set of papers used the concepts of ecological systems by also investigating interactions within and between these systems (N = 4). Another limited set of papers (N = 2) utilized the later concepts of proximal processes and the PPCT model. Our results show that studies using Bronfenbrenner’s ecological system concepts by clearly considering interactions between and within these systems can result in recommendations that are most useful for guiding public mental health policy and practice.

Place, publisher, year, edition, pages
Springer, 2018
National Category
Medical and Health Sciences Social Work
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-150965 (URN)10.1057/s41285-018-0065-6 (DOI)000455351600007 ()
Funder
Swedish Research Council Formas, 259-2012-37
Available from: 2018-08-21 Created: 2018-08-21 Last updated: 2019-02-11Bibliographically approved
Aronsson, G., Theorell, T., Grape, T., Hammarström, A., Hogstedt, C., Marteinsdottir, I., . . . Hall, C. (2017). A systematic review including meta-analysis of work environment and burnout symptoms. BMC Public Health, 17, Article ID 264.
Open this publication in new window or tab >>A systematic review including meta-analysis of work environment and burnout symptoms
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2017 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 264Article, review/survey (Refereed) Published
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.

Keywords
Burnout, Emotional exhaustion, Cynicism, Personal accomplishment, Job control, Job demands, Social pport, Review, Meta-analyses, GRADE system
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-133757 (URN)10.1186/s12889-017-4153-7 (DOI)000396680500005 ()28302088 (PubMedID)
Available from: 2017-05-03 Created: 2017-05-03 Last updated: 2018-06-09Bibliographically approved
Almquist, Y. B., Landstedt, E. & Hammarström, A. (2017). Associations between social support and depressive symptoms: social causation or social selection-or both?. European Journal of Public Health, 27(1), 84-89
Open this publication in new window or tab >>Associations between social support and depressive symptoms: social causation or social selection-or both?
2017 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 1, p. 84-89Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Numerous studies have demonstrated an association between social support and health, almost regardless of how social support and health have been conceptualised or measured. Even so, the issue of causality has not yet been sufficiently addressed. This issue is particularly challenging for mental health problems such as depressive symptoms. The aim of the present study is to longitudinally assess structural and functional aspects of social support in relation to depressive symptoms in men and women, through a series of competing causal models that, in contrast to many other statistical methods, allow for bi-directional effects.

METHODS: Questionnaire data from the Northern Swedish Cohort (n = 1001) were utilised for the years 1995 (age 30) and 2007 (age 42). Associations were analysed by means of gender-specific structural equation modelling, with structural and functional support modelled separately.

RESULTS: Both structural and functional support were associated with depressive symptoms at ages 30 and 42, for men and women alike. A higher level of support, particularly functional support, was associated with a decrease in depressive symptoms over time among men. Among women, there were bi-directional effects of social support and depressive symptoms over time.

CONCLUSION: Concerning social support and health, the social causation hypothesis seems relevant for men whereas, for women, the associations appear to be more complex. We conclude that preventive and health promoting work may need to consider that the presence of depressive symptoms in itself impedes on women's capability to increase their levels of social support.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-127464 (URN)10.1093/eurpub/ckw120 (DOI)000397046200020 ()27521575 (PubMedID)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2018-06-09Bibliographically approved
Brydsten, A., Gustafsson, P. E., Hammarström, A. & San Sebastian, M. (2017). Does contextual unemployment matter for health status across the life course? A longitudinal multilevel study exploring the link between neighbourhood unemployment and functional somatic symptoms. Health and Place, 43, 113-120
Open this publication in new window or tab >>Does contextual unemployment matter for health status across the life course? A longitudinal multilevel study exploring the link between neighbourhood unemployment and functional somatic symptoms
2017 (English)In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 43, p. 113-120Article in journal (Refereed) Published
Abstract [en]

This study examines whether neighbourhood unemployment is related to functional somatic symptoms, independently of the individual employment, across the life course and at four specific life course periods (age 16, 21, 30 and 42). Self-reported questioner data was used from a 26-year prospective Swedish cohort (n=1010) with complementary neighbourhood register data. A longitudinal and a set of age-specific cross-sectional hierarchal linear regressions was carried out. The results suggest that living in a neighbourhood with high unemployment has implications for residents' level of functional somatic symptoms, regardless of their own unemployment across time, particularly at age 30.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-131334 (URN)10.1016/j.healthplace.2016.11.014 (DOI)000394402400014 ()27997864 (PubMedID)
Funder
Swedish Research Council Formas, 259-2012-37Forte, Swedish Research Council for Health, Working Life and Welfare, 2011-0445
Available from: 2017-02-13 Created: 2017-02-13 Last updated: 2018-06-09Bibliographically approved
Jonsson, F., Sebastian, M. S., Hammarström, A. & Gustafsson, P. E. (2017). Intragenerational social mobility and functional somatic symptoms in a northern Swedish context: analyses of diagonal reference models. International Journal for Equity in Health, 16, Article ID 1.
Open this publication in new window or tab >>Intragenerational social mobility and functional somatic symptoms in a northern Swedish context: analyses of diagonal reference models
2017 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, article id 1Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Research indicate that social class mobility could be potentially important for health, but whether this is due to the movement itself or a result of people having been integrated in different class contexts is, to date, difficult to infer. In addition, although several theories suggest that transitions between classes in the social hierarchy can be stressful experiences, few studies have empirically examined whether such movements may have health effects, over and above the implications of "being" in these classes. In an attempt to investigate whether intragenerational social mobility is associated with functional somatic symptoms in mid-adulthood, the current study tests three partially contrasting theories.

METHOD: The dissociative theory suggests that mobility in general and upward mobility in particular may be linked to psychological distress, while the falling from grace theory indicates that downward mobility is especially stressful. In contrast, the acculturation theory holds that the health implications of social mobility is not due to the movement itself but attributed to the class contexts in which people find themselves. Diagonal Reference Models were used on a sample of 924 individuals who in 1981 graduated from 9(th) grade in the municipality of Luleå, Sweden. Social mobility was operationalized as change in occupational class between age 30 and 42 (measured in 1995 and 2007). The health outcome was functional somatic symptoms at age 42, defined as a clustering self-reported physical symptoms, palpitation and sleeping difficulties during the last 12 months.

RESULTS: Overall mobility was not associated with higher levels of functional somatic symptoms compared to being immobile (p = 0.653). After controlling for prior and current class, sex, parental social position, general health, civil status, education and unemployment, the association between downward mobility was borderline significant (p = 0.055) while upward mobility was associated with lower levels of functional somatic symptoms (p = 0.03).

CONCLUSION: The current study did not find unanimous support for any of the theories. Nevertheless, it sheds light on the possibility that upward mobility may be beneficial to reduce stress-related health problems in mid-life over and above the exposure to prior and current class, while downward mobility can be of less importance for middle-age health complaints.

Keywords
Sweden, Social mobility, Intragenerational, Social class, Life course, Diagonal reference model, Self-reported symptoms
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-130432 (URN)10.1186/s12939-016-0499-1 (DOI)000391407500001 ()28057005 (PubMedID)
Available from: 2017-01-19 Created: 2017-01-19 Last updated: 2018-11-12Bibliographically approved
Linander, I., Alm, E., Hammarström, A. & Harryson, L. (2017). Negotiating the (bio)medical gaze: Experiences of trans-specific healthcare in Sweden. Social Science and Medicine, 174, 9-16
Open this publication in new window or tab >>Negotiating the (bio)medical gaze: Experiences of trans-specific healthcare in Sweden
2017 (English)In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 174, p. 9-16Article in journal (Refereed) Published
Abstract [en]

In Sweden as well as in other western countries persons with trans experiences have to go through a clinical evaluation in order to get access to gender-confirming medical procedures. The aim of this study is to analyse care-users' experiences of navigating and negotiating access to gender-confirming medical procedures in Sweden. Biomedicalisation is used as a theoretical framework in order to analyse how technoscientific and neoliberal developments are parts of constructing specific experiences within trans-specific care. Constructivist grounded theory was used to analyse 14 interviews with persons having experiences of, or considering seeking, trans-specific healthcare. The participants experienced trans-specific healthcare as difficult to navigate because of waiting times, lack of support, provider ignorance and relationships of dependency between healthcare-users and providers. These barriers pushed the users to take responsibility for the care process themselves, through ordering hormones from abroad, acquiring medical knowledge and finding alternative support. Based on the participants' experiences, it can be argued that the shift of responsibility from care-providers to users is connected to a lack of resources within trans-specific care, to neoliberal developments within the Swedish healthcare system, but also to discourses that frame taking charge of the care process as an indicator that a person is in need of or ready for care. Thus, access to gender-confirming medical procedures is stratified, based on the ability and opportunity to adopt a charge-taking role and on economic and geographic conditions. Based on the results and discussion, we conclude that trans-specific care ought to focus on supporting the care-seekers throughout the medical process, instead of the current focus on verifying the need for care. There is also a need for increased knowledge and financial resources. A separation between legal and medical gender reassignment could contribute to a better relationship between care-providers and care-users and increase the quality of care.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Sociology Gender Studies
Identifiers
urn:nbn:se:umu:diva-129677 (URN)10.1016/j.socscimed.2016.11.030 (DOI)000393931200002 ()27960120 (PubMedID)
Available from: 2017-01-08 Created: 2017-01-08 Last updated: 2018-10-25Bibliographically approved
Byhamre, M. L., Gustafsson, P. E., Jansson, J.-H., Wennberg, M., Hammarström, A. & Wennberg, P. (2017). Snus use during the life-course and risk of the metabolic syndrome and its components. Scandinavian Journal of Public Health, 45(8), 733-740
Open this publication in new window or tab >>Snus use during the life-course and risk of the metabolic syndrome and its components
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2017 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 8, p. 733-740Article in journal (Refereed) Published
Abstract [en]

Objective: We aimed to investigate the association between life-course exposure to snus and prevalence of the metabolic syndrome and its components in adulthood.

Design and method: Tobacco habits at baseline (age 16) and three follow-ups (ages 21, 30 and 43) were assessed among 880 participants in a population-based cohort in Northern Sweden. Presence of the metabolic syndrome at age 43 was ascertained using the International Diabetes Federation criteria. Odds ratios and CIs for risk of the metabolic syndrome and its components by snus use at 16, 21, 30 and 43 years were calculated using logistic regression. Cumulative snus use was defined as number of life periods (1-4) with current snus use.

Results: At age 43, 164 participants (18.6%) were current snus users. We found no association between exclusive snus use at the ages of 16, 21, 30 and 43 years and the metabolic syndrome at age 43 years. Snus use (among non-smokers) was associated with raised triglycerides and high blood pressure in crude analysis, but not in multivariable models. There was no association between cumulative snus use and risk of the metabolic syndrome. Cumulative snus use was associated with central obesity, raised triglycerides and impaired fasting glucose/diabetes mellitus type 2 in crude analyses, but not after adjustments.

Conclusion: The health consequences of snus exposure from adolescence to mid-adulthood do not seem to include increased risk of the metabolic syndrome or its components. The cardio-metabolic risk of dual exposure to snus and cigarettes may warrant further attention.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Swedish moist snuff, hypertension, life-course, metabolic syndrome, metsy, obesity, smokeless tobacco, snus, triglycerides
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-143321 (URN)10.1177/1403494817706631 (DOI)000418185200001 ()28673132 (PubMedID)
Available from: 2017-12-20 Created: 2017-12-20 Last updated: 2018-06-09Bibliographically approved
Nilsson, K., Hammarström, A. & Strandh, M. (2017). The relationship between work and family preferences and behaviors: a longitudinal study of gender differences in Sweden. Acta Sociologica, 60(2), 120-133
Open this publication in new window or tab >>The relationship between work and family preferences and behaviors: a longitudinal study of gender differences in Sweden
2017 (English)In: Acta Sociologica, ISSN 0001-6993, E-ISSN 1502-3869, Vol. 60, no 2, p. 120-133Article in journal (Refereed) Published
Abstract [en]

Proposed theories to explain gender inequality in the labor market and family, such as gender specialization within families and gender segregation in the labor markets, lack consideration for individual preferences. Preference theory accounts for individual choice and gendered preferences but has been substantially criticized, indicating a need for further research. This study uses Swedish longitudinal data to explore how preferences for work and family relate to behavior. We explore three critical issues raised in previous research: gender differences in preferences; the relationship between work and family changes and subsequent preferences; how preferences relate to work and family behaviors. Our results showed small general gender differences in preferences, although women had a stronger preference for both children and work than men. Changes in work status were further related to changes in work preferences, while changes in family status were related to changes in family preferences. Moreover, preferences had poor predictive power in relation to work and family behaviors. Our results indicate that preferences do not explain gender inequality in Sweden. The relationship between preferences and behaviors seems bidirectional and preferences and behavior within the family sphere has little to do with preferences and behavior within the work sphere.

Keywords
Gender, family, labor market, preferences, longitudinal, Sweden
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology)
Identifiers
urn:nbn:se:umu:diva-124668 (URN)10.1177/0001699316659322 (DOI)000400089400002 ()
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2019-04-26Bibliographically approved
Projects
Developing a tool for analysing gender equity in health care - a gender theoretical approach to Swedish hospital-based health care [2009-05839_VR]; Umeå UniversityUnemployment and scarring - a life course analyses of the health consequences in adult age of youth unemployment in different economic trade cycles [2011-00445_Forte]; Umeå UniversityMental health in adolescence and the paths ahead. An ecological life course approach to mental health trajectories into adulthood [2012-37_Formas]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4095-7961

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