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  • 1. Almquist, Ylva B
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Associations between social support and depressive symptoms: social causation or social selection-or both?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 1, p. 84-89Article in journal (Refereed)
    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.

  • 2. Almquist, Ylva B.
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jackisch, J.
    Rajaleid, K.
    Westerlund, H.
    Hammarström, A.
    Growing through asphalt: What counteracts the long-term negative health impact of youth adversity?2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no Suppl_3, p. 47-47Article in journal (Other academic)
    Abstract [en]

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

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

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

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

    Key messages:

    • While the experience of disadvantageous living conditions in adolescence tends to translate into poor health development across the life course, this is not always the case.
    • Advantages related to school, peers, and spare time have the potential of counteracting the negative health impact of an adverse family context.
  • 3. Almquist, Ylva B.
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jackisch, Josephine
    Rajaleid, Kristiina
    Westerlund, Hugo
    Hammarstrom, Anne
    Prevailing over Adversity: Factors Counteracting the Long-Term Negative Health Influences of Social and Material Disadvantages in Youth2018In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 15, no 9, article id 1842Article in journal (Refereed)
    Abstract [en]

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

  • 4. Dahlqvist, Helene Zetterstrom
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Almqvist, Ylva B.
    Gadin, Katja Gillander
    A non-randomised pragmatic trial of a school-based group cognitive-behavioural programme for preventing depression in girls2017In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 76, article id 1396146Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the effectiveness of the DISA-programme in preventing depressive symptoms (DS) in adolescent girls, as implemented in a real-world school setting, accounting for baseline socioeconomic and psychosocial factors, and to investigate whether the effects of these baseline variables on DS differed between intervention participants and non-participants. In this non-randomised pragmatic trial, an electronic questionnaire was disseminated in 2011 (baseline) and 2012 (follow-up) in schools in one municipality in northern Sweden. Pupils (total n=275; intervention participants identified in the questionnaire: n=53; non-participants: n=222) were 14-15 years old at baseline. The groups were compared by means of SEM. DISA could not predict differences in DS at follow-up in this real-life setting. In the overall sample, sexual harassment victimisation (SH) at baseline was associated with DS at follow-up and the estimate for SH increased in the DISA-participants compared to the overall sample.

  • 5. Dahlqvist, Helene Zetterström
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Health Sciences, Mid Sweden University, 851 70 Sundsvall, Sweden.
    Young, Robert
    Gådin, Katja Gillander
    Dimensions of Peer Sexual Harassment Victimization and Depressive Symptoms in Adolescence: A Longitudinal Cross-Lagged Study in a Swedish Sample2016In: Journal of Youth and Adolescence, ISSN 0047-2891, E-ISSN 1573-6601, Vol. 45, no 5, p. 858-873Article in journal (Refereed)
    Abstract [en]

    Sexual harassment is commonly considered unwanted sexual attention and a form of gender-based violence that can take physical, verbal and visual forms and it is assumed to cause later depression in adolescents. There is a dearth of research explicitly testing this assumption and the directional pathway remains unclear. The purpose of this study was to use a feminist theoretical framework to test competing models in respect of the direction of the relationships between dimensions of peer sexual harassment victimization and dimensions of depressive symptoms from ages 14 to 16 in adolescents. The study also aimed to investigate gender differences in these pathways. Cross-lagged models were conducted using a three-wave (2010, 2011 and 2012) longitudinal study of 2330 students (51 % females) from Sweden, adjusted for social background. Girls subjected to sexual harassment in grade seven continued to experience sexual harassment the following 2 years. There was weaker evidence of repeated experience of sexual harassment among boys. Depressive symptoms were stable over time in both genders. Sexual name-calling was the dimension that had the strongest associations to all dimensions of depressive symptoms irrespective of gender. In girls, name-calling was associated with later somatic symptoms and negative affect, while anhedonia (reduced ability to experience pleasure) preceded later name-calling. Physical sexual harassment had a reciprocal relationship to somatic symptoms in girls. In boys, name-calling was preceded by all dimensions of depressive symptoms. It is an urgent matter to prevent sexual harassment victimization, as it is most likely to both cause depressive symptoms or a reciprocal cycle of victimization and depression symptoms in girls as well as boys.

  • 6.
    Landstedt, Evelina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Almquist, Ylva B.
    Eriksson, Malin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Disentangling the directions of associations between structural social capital and mental health: Longitudinal analyses of gender, civic engagement and depressive symptoms2016In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 163, p. 135-143Article in journal (Refereed)
    Abstract [en]

    The present paper analysed the directions of associations between individual-level structural social capital, in the form of civic engagement, and depressive symptoms across time from age 16-42 years in Swedish men and women. More specifically, we asked whether civic engagement was related to changes in depressive symptoms, if it was the other way around, or whether the association was bi-directional. This longitudinal study used data from a 26-year prospective cohort material of 1001 individuals in Northern Sweden (482 women and 519 men). Civic engagement was measured by a single-item question reflecting the level of engagement in clubs/organisations. Depressive symptoms were assessed by a composite index. Directions of associations were analysed by means of gender-separate cross-lagged structural equation models. Models were adjusted for parental social class, parental unemployment, parental health, and family type at baseline (age 16). Levels of both civic engagement and depressive symptoms were relatively stable across time. The model with the best fit to data showed that, in men, youth civic engagement was negatively associated with depressive symptoms in adulthood, thus supporting the hypothesis that involvement in social networks promotes health, most likely through provision of social and psychological support, perceived influence, and sense of belonging. Accordingly, interventions to promote civic engagement in young men could be a way to prevent poor mental health for men later on in life. No cross-lagged effects were found among women. We discuss this gender difference in terms of gendered experiences of civic engagement which in turn generate different meanings and consequences for men and women, such as civic engagement not being as positive for women's mental health as for that of men. We conclude that theories on structural social capital and interventions to facilitate civic engagement for health promoting purposes need to acknowledge gendered life circumstances. (C) 2016 Elsevier Ltd. All rights reserved.

  • 7.
    Landstedt, Evelina
    et al.
    Hälsovetenskap, Mitthögskolan, Sundsvall.
    Asplund, Kenneth
    Gillander Gådin, Katja
    Understanding adolescent mental health: the influence of social processes, doing gender and gendered power relations.2009In: Sociology of Health and Illness, ISSN 0141-9889, E-ISSN 1467-9566, Vol. 31, no 7Article in journal (Refereed)
    Abstract [en]

    Despite a well-documented gender pattern in adolescent mental health, research investigating possible explanatory factors from a gender-theoretical approach is scarce. This paper reports a grounded theory study based on 29 focus groups. The aim was to explore 16- to 19-year-old students' perceptions of what is significant for mental health, and to apply a gender analysis to the findings in order to advance understanding of the gender pattern in adolescent mental health. Significant factors were identified in three social processes categories, including both positive and negative aspects: (1) social interactions, (2) performance and (3) responsibility. Girls more often experienced negative aspects of these processes, placing them at greater risk for mental health problems. Boys' more positive mental health appeared to be associated with their low degree of responsibility-taking and beneficial positions relative to girls. Negotiating cultural norms of femininity and masculinity seemed to be more strenuous for girls, which could place them at a disadvantage with regard to mental health. Social factors and processes (particularly responsibility), gendered power relations and constructions of masculinities and femininities should be acknowledged as important for adolescent mental health.

  • 8.
    Landstedt, Evelina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Brydsten, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Public Health and Caring Sciences, Uppsala University.
    Virtanen, Pekka
    Almquist, Ylva B
    The role of social position and depressive symptoms in adolescence for life-course trajectories of education and work: a cohort study2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 1169Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While a vast amount of studies confirm the social reproduction of class and status from one generation to the next, less is known about the role of health in the child generation for these processes. Research has shown that particularly mental distress in adolescence is important for future life chances. This study aimed to examine the importance of parental socioeconomic position and depressive symptoms in youth for life-course trajectories of education and labour market attachment among men and women.

    METHODS: Based on four waves of questionnaire data from the Northern Swedish Cohort (n = 1,001), consisting of individuals born in 1965, three steps of gender-separate analyses were undertaken. First, the individual trajectories of education and labour market attachment from age 18 to 42 were mapped through sequence analysis. Second, cluster analysis was used to identify typical trajectories. Third, two indicators of parental socioeconomic position - occupational class and employment status - and depressive symptoms at age 16 were used in multinomial regression analyses to predict adult life-course trajectories.

    RESULTS: Four typical trajectories were identified for men, of which three were characterised by stable employment and various lengths of education, and the fourth reflected a more unstable situation. Among women, five trajectories emerged, characterised by more instability compared to men. Low parental occupational class and unemployment were significantly associated with a higher risk of ending up in less advantaged trajectories for men while, for women, this was only the case for occupational class. Youth levels of depressive symptoms did not significantly differ across the trajectories.

    CONCLUSIONS: This study found support for the intergenerational reproduction of social position, particularly when measured in terms of parental occupational class. Youth depressive symptoms did not show clear differences across types of trajectories, subsequently impeding such symptoms to trigger any selection processes. While this could be a consequence of the specific framework of the current study, it may also suggest that depressive symptoms in youth are not a root cause for the more complex processes through which how social position develops across life. The possible impact of welfare and labour market policies is discussed.

  • 9.
    Landstedt, Evelina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Coffey, Julia
    The social context of youth mental health2017In: Routledge handbook of youth and young adulthood / [ed] A Furlong, London: Routledge, 2017, 2, p. 346-355Chapter in book (Other academic)
  • 10.
    Landstedt, Evelina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin. Youth Research Centre, Melbourne Graduate School of Education, the University of Melbourne, Melbourne, VIC, Australia.
    Coffey, Julia
    Nygren, Maria
    Mental health in young Australians: a longitudinal study2016In: Journal of Youth Studies, ISSN 1367-6261, E-ISSN 1469-9680, Vol. 19, no 1, p. 74-86Article in journal (Refereed)
    Abstract [en]

    This article discusses patterns in mental health of young Australians from age 19 through 25 and explores changes in mental health over these years. Data are derived from five waves of the Australian Life Patterns longitudinal study. The outcome variable in focus was self-reported mental health. Analyses were conducted in two steps using linear mixed models with both fixed and random effects. The analysis shows a negative linear trend in mental health status. The mental health of women was worse than that of men though a negative trend was found in both men and women. Though high socio-economic status (SES) individuals reported best mental health compared to their mid and low-SES peers, a negative trend was identified for them as well as for mid-SES participants. There is weak support for a negative trend among those of low-SES backgrounds. The study adds to evidence that there is a negative trend in mental health in young Australians but that this trend is not uniform across all young people. In light of this we argue the need for further research that analyses patterns of poor mental health in relation to social systems and institutions.

  • 11.
    Landstedt, Evelina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Coffey, Julia
    Wyn, Johanna
    Cuervo, Hernán
    Woodman, Dan
    The complex relationship between mental health and social conditions in the lives of young Australians mixing work and study2017In: Young - Nordic Journal of Youth Research, ISSN 1103-3088, E-ISSN 1741-3222, Vol. 25, no 4, p. 339-358Article in journal (Refereed)
    Abstract [en]

    Poor mental health in youth has been consistently shown to be rising over the past 20 years. While it is well established that mental health status is associated with social conditions, population-level perspectives make it difficult to identify the complex ways social and structural conditions impact on mental health. Based on longitudinal (mixed method) data, this exploratory longitudinal study aims to study how the life circumstances of education, work and financial situation are related to mental health in young Australians (aged 20-22). Findings show that the combination of study, work and financial hardship can be regarded as a stressor contributing to poor mental health, particularly if experienced over several years, and that those in the middle socio-economic bracket have the worst mental health outcomes. This research has implications for welfare policies and the responsibilities of educational institutions for the welfare of young people.

  • 12.
    Landstedt, Evelina
    et al.
    Hälsovetenskap, Mitthögskolan, Sundsvall.
    Gillander Gådin, Katja
    Deliberate self-harm and associated factors in 17-year-old Swedish students.2011In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Deliberate self-harm (DSH) in young people is an important public health issue. To prevent DSH, more knowledge is needed about its prevalence and associated contextual factors in community samples of adolescents.

    AIMS: To determine the prevalence of deliberate self-harm in 17-year-old Swedish students and to explore the association of demographic variables, psychological distress, experiences of violence, and school-related factors with DSH.

    METHODS: Data were derived from a cross-sectional study in which 17-year-old students completed questionnaires during school hours (n = 1,663; 78.3%). The variables used in this analysis are as follows: deliberate self-harm, demographic variables, psychological distress, experiences of violence, and school-related factors. Data were analysed using chi-squared statistics and logistic regression.

    RESULTS: The lifetime prevalence of DSH was 17%, and it was more common among girls (23.3%) than boys (10.5%). There were considerable socioeconomic differences in reports of DSH. Psychological distress was strongly associated with DSH in both boys and girls, as were experiences of bullying, sexual harassment, physical violence and sexual assault. Social support, safety and academic factors in school were related to reports of DSH in both girls and boys. There were some gender differences with respect to which factors were associated with DSH.

    CONCLUSIONS: Deliberate self-harm is common and more frequently reported by girls than boys. Psychological distress, experiences of different types of violence, and school-related factors (academic, social and safety-related), should be considered risk factors for DSH in young people. Findings can be applied to health-promotion policy and interventions in various contexts, for example schools.

  • 13.
    Landstedt, Evelina
    et al.
    Hälsovetenskap, Mitthögskolan, Sundsvall.
    Gillander Gådin, Katja
    Experiences of violence among adolescents: gender patterns in types, perpetrators and associated psychological distress.2011In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 56, no 4Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To explore the psychological distress associations of experiences of several types of violence and the victim-perpetrator relationship of physical violence, a gender analysis was applied.

    METHODS: Data were derived from a cross-sectional questionnaire study among 17-year-old upper secondary school students (N = 1,663). Variables in focus were: self-reported psychological distress, experiences of physical violence, sexual assault, bullying and sexual harassment. Logistic regressions were used to examine associations.

    RESULTS: Experiences of physical violence, sexual assault, bullying and sexual harassment were associated with psychological distress in boys and girls. The perpetrators of physical violence were predominately males. Whether the perpetrator was unknown or known to the victim seem to be linked to psychological distress. Victimisation by a boyfriend was strongly related to psychological distress among girls.

    CONCLUSIONS: Experiences of several types of violence should be highlighted as factors associated with mental health problems in adolescents. The victim-perpetrator relationships of violence are gendered and likely influence the psychological distress association. Gendered hierarchies and norms likely influence the extent to which adolescents experience violence and how they respond to it in terms of psychological distress.

  • 14.
    Landstedt, Evelina
    et al.
    Hälsovetenskap, Mittuniversitetet, Sundsvall.
    Gillander-Gådin, Katja
    Seventeen and stressed – Do gender and class matter?2012In: Health Sociology Review, ISSN 1446-1242, E-ISSN 1839-3551, Vol. 21, no 1, p. 82-98Article in journal (Refereed)
    Abstract [en]

    Despite concerns about stress levels in young people, research about stress and stressors among boys and girls that apply an intersectionality approach is scarce. This cross-sectional study explored gender, class (indicated by academic orientation) and multi-group (gender/class) patterning of perceived stress and reported stressors in a sample of 1,663 17-year-old Swedish students. The students, especially girls, were highly stressed. No class differences were found. Performance-related stressors were predominately indicated by students in academic programmes and girls (regardless of class). Looks-related stress was more common among girls than boys, whilst economic and relational stressors were mostly indicated by vocational programme students, particularly girls. There was a complex gender and class patterning of stress due to demands and lack of money. The interplay of gender and class should be acknowledged in identifying determinants of stress in young people. Possible implications for mental health are discussed.

  • 15.
    Landstedt, Evelina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Gustafsson, Per E.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Johansson, Klara
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Longitudinal associations between social relationships at age 30 and internalising symptoms at age 42: findings from the Northern Swedish Cohort.2016In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 61, no 1, p. 75-81Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Little is known on long-term consequences of poor social relationships in adulthood. The study aimed to examine associations between social relationships at age 30 and internalising symptoms at age 42.

    METHODS: Data was drawn from four waves of the Northern Swedish cohort (n = 1001, 94 % response rate). The outcome internalising symptoms was measured by a composite index of depressiveness and anxiety. A cumulative measure was constructed to reflect various aspects of social relationships. Multivariate ordinal logistic regressions were used, controlling for socioeconomic indicators and previous level of internalising symptoms.

    RESULTS: An accumulation of poor social relationships indicators at age 30 is related to internalising symptoms at age 42 in women (OR 1.30; CI 1.11-1.52) and men (OR 1.17; CI 1.02-1.36). The associations remained significant after adjustment for covariates.

    CONCLUSIONS: Poor quality of social relationships at age 30 can predict internalising symptoms 12 years later in both men and women even when previous mental health as well as financial disadvantage is accounted for. More research is required to further examine pathways and mechanisms as well as suitable interventions.

  • 16.
    Landstedt, Evelina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarström, Anne
    Fairweather-Schmidt, A. Kate
    Wade, Tracey
    Associations between adolescent risk for restrictive disordered eating and long-term outcomes related to somatic symptoms, body mass index, and poor well-being2018In: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 23, no 2, p. 496-518Article in journal (Refereed)
    Abstract [en]

    Objective: To date, no longitudinal, community-based studies have examined the association between disordered eating emerging in adolescence and long-term physical well-being. This study sought to explore the longitudinal associations between risk for restrictive disordered eating (DE-R; those not presenting with binge-purge symptoms) in adolescence and trajectories of functional somatic symptoms (FSS) and body mass index (BMI), and several indicators of poor physical well-being across early- to mid-adulthood, including medication, number of doctor visits, and sick leave. Design: Data were obtained from the Northern Swedish Cohort Study (N=1,001), a prospective longitudinal study including four time points from age 16 to 42 years. Methods: A cumulative measure of DE-R risk was computed. Latent class growth analysis was used to identify subpopulation trajectories of FSS and BMI. The three-step method for auxiliary variables and logistic regressions were used to assess associations between DE-R and the trajectory classes as well as indicators of poorphysical well-being. ResultsThree trajectories were identified for FSS. A gender by BMI interaction led to a classification of four BMI trajectories in men, but three in women. The presence of DE-R risk in adolescence increased odds of unfavourable FSS development, increasing BMI in women, and continually low BMI in men. Indicators of poor physical well-being at ages 21, 30, and 42years were associated with DE-R risk in adolescence. Conclusions: Data spanning nearly three decades suggest that physical well-being impairment is related to DE-R risk measured earlier in life, underscoring the urgency for targeted, gender-sensitive preventive interventions for teenagers. What is already known on this subject? Disordered eating is linked to poor physical and mental well-being and quality of life. No longitudinal studies have examined long-term physical well-being consequences of adolescent disordered eating risk. What does this study add? Non-purging disordered eating symptoms in adolescence predict adverse physical well-being outcomes in middle-aged men and women. Targeted interventions and preventative work during adolescence are needed.

  • 17.
    Landstedt, Evelina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Winefield, Helen
    How well do parental and peer relationships in adolescence predict health in adulthood?2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 5, p. 460-468Article in journal (Refereed)
    Abstract [en]

    Aim: Although health effects of social relationships are well-researched, long-term health consequences of adolescent family as well as peer relationships are poorly understood. The aim of the study was to explore the prospective importance of parental and peer social relationships in adolescence on internalising and functional somatic symptoms in adulthood. Methods: Data were drawn from four waves of the Northern Swedish Cohort Study, response rate 94.3%, N=1001. Outcome variables were internalising and functional somatic symptoms at the ages of 21, 30 and 42. Relationship variables at age 16 were poor parental contact and three indicators of poor peer relationships. Associations were assessed in multivariate ordinal logistic regressions with adjustment for confounders and baseline health. Results: Results show that the main relationships-related predictors of adult internalising symptoms were self-rated poor peer relationships in terms of spending time alone during after-school hours and poor parental relationship. Functional somatic symptoms on the other hand were most strongly associated with poor parental contact and not being happy with classmates at age 16. Conclusions: The quality of parental and peer relationships in adolescence predicts adult mental and functional somatic health as much as 26 years later, even when accounting for confounders and adolescent symptomatology. This study extends past research by exploring how both adolescent parental and peer relationships (self-reported as well as teacher reported) predict adult self-reported health.

  • 18.
    Landstedt, Evelina
    et al.
    Hälsovetenskaper, Mitthögskolan, Sundsvall.
    Persson, Susanne
    Bullying, cyberbullying, and mental health in young people.2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 4Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the factors associated with exposure to in-real-life (IRL) bullying, cyberbullying, and both IRL and cyberbullying and to explore the relationship between these types of bullying and mental health among 13-16-year-old Swedish boys and girls.

    METHODS: Data was derived from a cross-sectional web-based study of 13-16-year-old students in northern Sweden (n=1214, response rate 81.9%).

    RESULTS: The combination of IRL- and cyberbullying was the most common type of bullying. A non-supportive school environment and poor body image were related to exposure to bullying for both genders but the relationship was more distinct in girls. All types of bullying were associated with depressive symptoms in both boys and girls and all forms of bullying increased the likelihood of psychosomatic problems in girls.

    CONCLUSIONS: Cyberbullying can be seen as an extension of IRL bullying. A combination of IRL- and cyberbullying seems to be particularly negative for mental health. Interventions should focus on improved school environment and body image as well as anti-violence programmes. Gender aspects of bullying need to be acknowledged.

  • 19.
    Landstedt, Evelina
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    San Sebastian, M.
    Complex inequalities of gender and social class in daily smoking among Swedish men and women2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 325-325Article in journal (Other academic)
    Abstract [en]

    Background: Cigarette smoking is a major public health threat. In high income countries, smoking is most prevalent in disadvantaged groups. Little is known about complex inequalitites in smoking based on multiple axes of social positions which would be necessary in designing interventions aiming at reducing smoking rates. The study aimed to describe the prevalence of daily smoking in the adult Swedish population across combinations of the social positions gender and occupational class, and to examine smoking differences attributed to the intersection of gender/occupational class

    Methods: The study sample (N = 61 316, age 26 – 84) was pooled from seven years of the annual cross sectional Swedish national public health surveys (2010 to 2016). The outcome was current daily smoking. Binary variables of gender (man/woman) and occupational class (blue collar/white collar) were used to construct the four category intersection meausure of gender/class. Complex inequalities in daily smoking were estimated by joint-, referent- and excess disparities. Survey year and age were used as covariates.

    Results: The overall daily smoking prevalence was 10.21%. The smoking rates in the categories of gender and occupational class were as follows: white collar men: 6.70%; white collar women: 7.79%; blue collar men: 13.75% and blue collar women: 16.63%. The absolute joint disparity was 9.96 percentage points (CI: 9.14 – 10.79) and that the main contributor to this inequality was occupational class (70.66%). The results of excess disparity further showed that blue collar women were particularly exposed regarding smoking.

    Conclusions: Acknowledging the complexity of disadvantage and privilege regarding daily smoking contributes to an understanding of the situation for multiply marginalised groups, for example blue collar women. The findings may inform future public health interventions to reduce smoking habits.

    Key messages:

    • Acknowledging the complexity of disadvantage and privilege contributes to an understanding of daily smoking across multiply marginalised groups.

    • Blue collar women is a particularly important group to consider in public health efforts to reduce smoking.

  • 20. Wyn, Johanna
    et al.
    Cuervo, Hernan
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    The limits of wellbeing2014In: Rethinking youth wellbeing: critical perspectives / [ed] Katie Wright, Julie McLeod, Singapore: Springer, 2014, p. 55-70Chapter in book (Refereed)
    Abstract [en]

    This chapter addresses the complex interrelationship between wellbeing as a personal responsibility and individual experience and the reality that the parameters of wellbeing across populations are social, political and economic. It focuses on the issue of mental health, which is recognized as one of the most significant challenges to young people’s health in developed countries. The nexus between social determinants of wellbeing and individual experience of being well is at the heart of the project of rethinking youth wellbeing. Drawing on longitudinal data from the Life Patterns research program about generation X and Y Australians, this chapter explores the relationship between contemporary social conditions – such as the increased time spent in formal education; the rise of precarious work; the fragmentation of time with significant others; and the tendency to combine study and work – and the deterioration of mental health rates. Data from the Life Patterns program suggests that young people experience wellbeing as yet another dimension of life in which they must perform to normative standards, and for which they are responsible. Rethinking youth wellbeing to acknowledge the social processes that shape emotional and social health leads to the conclusion that governments, institutions and workplaces bear responsibility for the mental health of young people.

  • 21. Zetterström Dahlqvist, H.
    et al.
    Landstedt, Evelina
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Gillander Gådin, K.
    A Latent Class Analysis of Violence Multi-Victimization in Youth2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, p. 483-484Article in journal (Other academic)
    Abstract [en]

    Background: Violence among youth is common and has been linked to poor mental health outcomes. There is some evidence that there are groups of youth who are victims of more than one form of violence but more knowledge is needed in terms of patterning of subgroups of multiple violence victimization.

    Aim: To explore if there are distinct subgroups of youth with particular patterns of violence victimization.

    Methods: Survey data from a Swedish sample (n = 1,569) of youth 14-16 years old were used (females 48.4%). Using a broad definition of violence, respondents indicated if they had experienced physical violence, threat of physical violence, bullying, sexual harassment, cyber bullying, online sexual victimizayion, and other adverse sexual experience in the past six months as well as lifetime physical violence victimization. Distinct subgroups of youth within the data set with particular patterns of violence victimization were identified using Latent Class Analysis (LCA). Model fit was assessed using the Akaike information criterion (AIC) and the Bayesian information criterion (BIC), with smaller values indicating better model fit.

    Results: Preliminary results show three distinct subgroups: 1. Sexualized violence off- and online (girls 66.6%), 2. Bullying only (girls 47.5%) and 3. Multi-victimization including threat of physical violence, violence in the past six months and lifetime, sexual harassment on- and offline, bullying on- and offline as well as other adverse sexual experience (girls 47.6%).

    Conclusions: Three distinct subgroups of violence victimization in a sample of 14-16 year old youth was evident in the data. There was a greater representation of girls in the sexualized violence sub-group. Further research as well as preventive programs should acknowledge that many young people are victims of several types of violence. Future research should also investigate the implications of multi-victimization on mental health outcomes.

    Key messages:

    • Three distinct subgroups of violence victimization was present in the data: 1. Sexualized violence off- and online 2. Bullying only and 3. Multi-victimization.

    • While the gendered pattern of the Bullying only and Multi-victimization subgroups were fairly balanced, a substantially greater proportion of girls were represented in the Sexualized violence group.

  • 22. Zetterström Dahlqvist, Heléne
    et al.
    Landstedt, Evelina
    Hälsovetenskap, Mittuniversitetet, Sundsvall.
    Gillander Gådin, Katja
    Depressive symptoms and the associations with individual, psychosocial, and structural determinants in Swedish adolescents2012In: Health, ISSN 1949-5005, Vol. 4, no 10, p. 881-889Article in journal (Refereed)
    Abstract [en]

    Depressive symptoms in adolescents are an in-creasing public health issue in Sweden and in most Western countries. Aim: To explore how individual, psychosocial, and structural deter-minants are associated with depressive symp-toms in Swedish adolescents. Methods: A web- based questionnaire was answered by 1193 13- to 16-year-old boys (n = 566) and girls (n = 627). Stepwise logistic regressions were employed to analyse the association between depressive sym- ptoms and various determinants at the individ-ual level (self-efficacy), the psychosocial level (parental, peer, and teacher support, school de-mands, sexual harassment, and bullying) and the structural level (family affluence, having less money than friends, and parental foreign back-ground). Results: Determinants at the individual, psychosocial, and structural levels were inde-pendently associated with high levels of depres-sive symptoms in both boys and girls. The full model explained a high proportion of the vari-ance in depressive symptoms in both genders; 34.1% in boys and 36.8% in girls. The psycho-social level contributed the most to explaining the variance in depressive symptoms in boys. In girls, when harassment variables were separated from psychosocial variables, the harassment var- iables contributed as much to the full model as the rest of the psychosocial variables combined. Conclusions: Addressing psychosocial determi-nants provides the greatest benefits for prevent-ing depressive symptoms in adolescents. Ac-knowledging the association between sexual harassment and depressive symptoms for girls and having less money than their friends for boys and girls are particularly important.

  • 23. Zetterström Dahlqvist, Heléne
    et al.
    Landstedt, Evelina
    Department of Health Sciences, Mitthögskolan, Sundsvall.
    Gillander Gådin, Katja
    What students do schools allocate to a cognitive-behavioural intervention?: Characteristics of adolescent participants in Northern Sweden2015In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 74, article id 29805Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Adolescents are a vulnerable group when it comes to the risk of developing depression. Preventing the onset of depressive episodes in this group is therefore a major public health priority. In the last decades, school-based cognitive-behavioural interventions have been a common primary prevention approach. However, evidence on what girls actually are allocated to such interventions when no researchers are involved is scarce.

    OBJECTIVE: To explore how a selective cognitive-behavioural program (Depression In Swedish Adolescents) developed to prevent depression in adolescents, was implemented in a naturalistic setting in schools in northern part of Sweden. The focus was on characteristics of participants allocated to the intervention.

    DESIGN: Cross-sectional baseline data on depressive symptoms, school environment and socio-economic factors were collected in 2011 by means of questionnaires in schools in a municipality in the northern part of Sweden. Intervention participants were identified in a follow-up questionnaire in 2012. Students (n=288) included in the analyses were in the ages of 14-15.

    RESULTS: Sixty-six girls and no boys were identified as intervention participants. They reported higher levels of depressive symptoms, lower personal relative affluence, more sexual harassment victimization and less peer support compared to female non-participants (n=222). Intervention participants were more likely to attend schools with a higher proportion of low parental education levels and a lower proportion of students graduating with a diploma.

    CONCLUSIONS: The developers of the intervention originally intended the program to be universal or selective, but it was implemented as targeted in these schools. It is important for school administrations to adhere to program fidelity when it comes to what students it is aimed for. Implications for effectivenss trials of cognitive-behavioural interventions in the school setting is discussed.

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