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Much theory asserts that sexual intimacy sustains mental health. Experimental tests of such theory remain rare and have not provided compelling evidence because ethical, practical, and cultural constraints bias samples and results. An epidemiologic approach would, therefore, seem indicated given the rigor the discipline brings to quasi-experimental research. For reasons that remain unclear, however, epidemiologist have largely ignored such theory despite the plausibility of the processes implicated, which engender, for example, happiness, feelings of belonging and self-worth, and protection against depression. We use an intent-to-treat design, implemented via interrupted time-series methods, to test the hypothesis that the monthly incidence of suicide, a societally important distal measure of mental health in a population, decreased among Swedish men aged 50–59 after July 2013 when patent rights to sildenafil (i.e., Viagra) ceased, prices fell, and its use increased dramatically. The test uses 102 pre, and 18 post, price-drop months. 65 fewer suicides than expected occurred among men aged 50–59 over test months following the lowering of sildenafil prices. Our findings could not arise from shared trends or seasonality, biased samples, or reverse causation. Our results would appear by chance fewer than once in 10,000 experiments. Our findings align with theory indicating that sexual intimacy reinforces mental health. Using suicide as our distal measure of mental health further implies that public health programming intended to address the drivers of self-destructive behavior should reduce barriers to intimacy in the middle-aged populations. [ABSTRACT FROM AUTHOR]

How does the likelihood of encountering wildlife affect residents' expectations about psychological restoration when visiting a local natural setting, and their choices among settings for future recreation? Do urban and rural residents differ in such expectations and choices? We addressed these questions in a web-based experiment with 223 adult residents randomly sampled from urban and rural areas in each of three regions in Sweden. Residents in all six areas can encounter fear-irrelevant wildlife (roe deer, squirrel) near the home, but the presence of fear-relevant wildlife (wolf, wild boar) differs across the areas. The respondents read scenarios concerning encounters with each of these four animals during recreational visits to a nearby natural setting. The scenarios varied in how frequently the person could expect to encounter each animal across visits (never, sometimes, often). For all 12 scenarios, respondents answered questions about anticipated experiences and restoration outcomes, and the effect of encounter likelihood on future recreational setting choices. Across all areas, with all outcomes, increased likelihood of encounters with the wolves and wild boar detracted from anticipated restorative potential, whereas increased likelihood of encounters with roe deer and squirrel enhanced anticipated restorative potential. A similar pattern showed in recreational setting choices. A domination wildlife value orientation moderated the effects of encounter likelihood for wolf and wild boar, whereas a mutualistic orientation moderated the effects of encounter likelihood for squirrel and roe deer. Our results suggest that wildlife management and public health practice could work together not only to address the fears of residents, but also to enhance the restorative quality of local natural settings by protecting wildlife. • Wildlife are neglected dynamic aspects of natural settings visited for restoration. • Residents rated scenarios crossing wildlife species with levels of local presence. • Fear-relevant animals constrained the restorative potential of nearby nature. • Fear-irrelevant animals promoted the restorative potential. • Findings reinforce links between wildlife management and public health practice. [ABSTRACT FROM AUTHOR]

Background Researchers often invoke a mortality displacement or 'harvesting' mechanism to explain mortality patterns, such that those with underlying health vulnerabilities die sooner than expected in response to environmental phenomena, such as heat waves, cold spells and air pollution. It is unclear if this displacement mechanism might also explain observed increases in suicide following economic contraction, or if suicides are induced in persons otherwise unlikely to engage in self-destructive behaviour. Here, we test two competing hypotheses explaining an observed increase in suicides following unemployment--induction or displacement. Methods We apply time series methods to monthly suicide and unemployment data from Sweden for the years 2000-2011. Tests are conducted separately for working age (20-64 years old) men and women as well as older (aged 65 years and older) men and women. Results Displacement appeared among older men and women; an unexpected rise in unemployment predicted an increase in suicides 6 months later, followed by a significant decrease 8 months later. Induction appeared among working age men, but not among working age women; an unexpected rise in unemployment predicted an increase in suicides 4-6 months later. Conclusions Displacement and induction both appear to have operated following unexpected labour market contractions in Sweden, though with different population segments. [ABSTRACT FROM AUTHOR]

Abstract: In higher latitudes, relatively cold summer weather may constrain outdoor activities that provide relief from chronic stress. Chronic stress can affect human birth outcomes, including the length of gestation and so the birth weight of the infant. We tested the hypothesis that, in Sweden, the odds of very low birth weight (VLBW; <1500g) vary inversely with mean monthly temperature for the summer months. We applied time-series modeling methods to nationally aggregated data on singleton births during the 456 months from January, 1973, through December, 2010. We found elevated odds of VLBW among male infants for relatively cold June and August temperatures. Unpleasant weather may figure in stress-related health outcomes, not only as a stressor, but also as a constraint on restoration. [Copyright &y& Elsevier]

Abstract: People who perform paid work may benefit from psychological restoration afforded by a leisure home and its natural surroundings. This may hinder the development of some forms of life-threatening illness. Using longitudinal register data for 108,114 employed Swedes, we assessed the prospective association between leisure home ownership and death before age 65. Among men, but not among women, leisure home owners had lower odds of early death, after adjustment for sociodemographic and residential characteristics (OR=0.875, 95% CI=0.702–0.980). The results bear on natural environments as health resources, inform debate on urban densification, and broaden the discussion of residence and health [Copyright &y& Elsevier]

How can societies ensure urban residents' access to health-promoting green spaces while also pursuing the benefits of densification? Evidence of a relationship between leisure home ownership and health can inform efforts to resolve this dilemma. Using longitudinal register data, we assessed the prospective association between ownership of a leisure home and early retirement for health reasons among 42588 adults residing in high-density Swedish urban municipalities. The research design included controls for 'drift' of unhealthy people into particular residential circumstances, and other potential alternative explanations for the association of focal interest. After adjustment for age, socioeconomic position, and type of primary housing, logistic regression analysis revealed that men with a leisure home had lower odds of early retirement for health reasons than men who did not own a leisure home. Among women, leisure home ownership interacted with socioeconomic position; in contrast to nonowners, women who owned a leisure home had higher odds of early retirement for health reasons if they also had higher levels of education and employment income. The associations we have uncovered provide additional insight on the relationship between access to natural environments and health, and they warrant consideration in efforts to resolve the densification dilemma. [ABSTRACT FROM AUTHOR]

Aims: To assess the association between housing tenure and early retirement for health reasons in Sweden with a view to psychosocial vs. material values of home ownership. Methods: The data come from linked registers that cover all people resident in Sweden during 1990–2000. The study population consists of 449,233 people aged 40–63 years in 1997. Of these, 19,350 retired early for health reasons in 1998–99. The remaining 429,883 continued their employment without extended sick leave or income decline. None moved during 1990–2000. We calculated the odds of early retirement for four forms of juridical relationship to one's housing (private owner; part owner in a cooperative; private rental; rental from a public housing company), for men and women separately, controlling for age, education, employment income, household disposable income, region, foreign birth, and housing type. Results: Men in cooperative ownership had lower odds of early retirement than those in the three other tenure forms, for which the odds were similar. Among women, public and private renters had similar odds of early retirement, which were higher than those of women in private or cooperative ownership. For both genders, inclusion of housing type in the model after housing tenure explained little additional variance. Conclusions: The odds of early retirement for health reasons varied across different housing tenure forms in Sweden in 1998–99. The pattern of associations differed as a function of gender. Home ownership appears to involve health resources independent of basic sociophysical factors captured with differences in housing type. [ABSTRACT FROM AUTHOR]

Well-developed theory implies that the human secondary sex ratio moves inversely over time with the level of anxiety and depression in the population. Few tests of this hypothesis, however, appear in the voluminous literature concerned with the sex ratio. These tests, moreover, employ designs that allow only weak inference. We contribute to the literature by applying time-series methods to Swedish data for the 276 months beginning January 1974 to detect a relationship between the sex ratio and defined daily doses of antidepressants and anxiolytics dispensed to women. Consistent with theory, we find the drug variable inversely related to the sex ratio. We argue that the discovered association cannot be attributed to shared trends, cycles, or other forms of autocorrelation in the data, or to the problem of endogeneity that necessarily plagues studies based on samples of individual women and births. Implications include that surveillance systems might monitor dispensing of anxiolytics and antidepressants as a marker for population stress thought to be a risk factor for adverse pregnancy outcomes such as preterm delivery. [ABSTRACT FROM AUTHOR]

Background:. The ecological association between contracting labor markets and admissions to inpatient psychiatric treatment has been widely replicated, but little understood, in the United States. Its explanations include the “uncovering mechanism” that assumes a contracting labor market does not increase the incidence of illness, but rather decreases the ability of chronically ill persons or their families to pay the direct and indirect costs of outpatient care. Without such care, some of these persons supposedly become more ill and eventually require inpatient treatment subsidized by the state. This explanation would not apply to a society with universal access to high quality mental health services. The uncovering mechanism, therefore, would be less compelling if the ecological association were found in such a society. We apply time-series methods to data for the 336 months beginning January 1973 to determine if the association appears in Sweden. Results:. Consistent with the findings from the United States, inpatient admissions of Swedish men and women move inversely over time with changes in the number of each employed. Conclusions:. The uncovering mechanism cannot explain the Swedish findings. Its rivals, including the argument that economic contraction either increases the incidence of illness or reduces tolerance for the persistently mentally ill, deserve more attention at least in countries with universal access to care. We offer research strategies for discriminating between these remaining rivals. [ABSTRACT FROM AUTHOR]

Prime minister Olof Palme's murder in 1986 and the sinking of the ferry Estonia in 1994 were stressful events for many Swedes, but did that stress affect health? We use an interrupted time-series design to measure the association between these events and the incidence of very low birthweight. Effects of male unemployment, size of the birth cohort, and temperature were controlled in our analysis of data for the period 1973-1995. The incidence of very low birthweight rose significantly in the months following the Palme murder and the Estonia catastrophe. Events that trigger communal bereavement at the scale we study may seem rare but they do occur (e.g., destruction of the World Trade Center and attack on the Pentagon). Events with less visibility, moreover, may induce communal bereavement in smaller populations defined by geography or organizational participation. [ABSTRACT FROM AUTHOR]

[Display omitted] • Spatial modelling of place use and wellbeing in Sweden during COVID-19. • Easy access to natural settings supports wellbeing under "soft-touch" restrictions. • No evidence for a link between population density of visited places and wellbeing. • Equitable access to natural settings can increase urban resilience towards pandemics. • Strategies can synergize with climate change mitigation and biodiversity protection. The coronavirus pandemic entailed varying restrictions on access, movement and social behavior in populations around the world. Knowledge about how people coped with "soft-touch" restrictions can inform urban spatial planning strategies that enhance resilience against future pandemics. We analyzed data from an online place-based survey on 2845 places across Sweden that respondents abstained from visiting, visited with similar frequency, or visited more frequently in spring 2020 as compared to before the pandemic. In spatial logistic regression models, we relate geographical and sociodemographic properties of places (fields, forests, water, residential population density and daytime population density) to self-perceived changes in wellbeing from visiting the given place less or more often, respectively. Abstaining from visiting places with natural features located in areas of high residential density was associated with a self-perceived negative influence on wellbeing. Yet, fields, forests and water were strongly associated with places people claimed wellbeing benefits from during pandemic restrictions. The further a visited place was from the respondent's home, the more likely it was to have a positive wellbeing influence. As an illustrative case, we map our models onto the landscape of Stockholm, showing that some neighborhoods are likely more resilient than others when coping with pandemic restrictions. Both the most and least resilient neighborhoods span the socio-economic spectrum. Urban planning will do well to enable equitable, easy access to natural settings by foot or bike, to increase pandemic preparedness as well as support climate change mitigation and biodiversity protection. [ABSTRACT FROM AUTHOR]

Little attention has been paid to the ecological effects of unemployment, despite strong theory suggesting that being socially or economically connected to unemployed persons can induce illness. Theory suggests, for example, that the labor market experience of adult males should affect maternal and infant health. We advance this line of inquiry by testing the hypothesis that quarterly increases in unemployment among Norwegian and Swedish males were associated with increased incidence of very low weight births from 1973 through 1995. Results support the hypothesis. We estimate that approximately 188 very low weight births could have been averted in Norway, and about 329 in Sweden, if quarterly increases in male unemployment had been constrained to the median over the 23-year period. Our findings imply that the social cost of unemployment may be underestimated by focusing on unemployment as an individual risk factor. [ABSTRACT FROM AUTHOR]

Background: Outpatient prescription medication spending in Sweden has increased sharply since 1974. The Swedish government has raised copayments to reduce medication consumption and limit the growth of medication spending.Objective: The aim of this study was to examine the effect of the 1995 and 1997 copayment increases on Swedish consumption of antidepressants, anxiolytics, sedatives.Methods: Monthly drug-use data for July 1990 through December 1999 for these 3 pharmaceutical classes were obtained from Apoteket AB (Stockholm, Sweden). Data were provided for both sexes in units of defined daily doses per 1000 inhabitants. These series were analyzed with the use of Box-Jenkins autoregressive, integrated, moving-average time-series modeling methods.Results: Dispensing of all 3 drugs classes increased immediately before copayment changes, with the exception of male sedative use at the time of the 1997 reform. Permanent increases in male antidepressant and sedative use occurred before the 1995 copayment reform. Only female antidepressant use was permanently reduced following the 1997 copayment reform.Conclusions: Our findings suggest that Swedish patients'' valuation of mental health medications exceeds the enacted price increases. The permanent increases in male antidepressant and sedative use, beginning in 1995, may have been the result of previous undertreatment. The permanent reduction in female antidepressant use, beginning in 1997, suggests that the price levels reached a threshold that matched or exceeded Swedish women''s valuation of these modific [Copyright &y& Elsevier]

Abstract: Much medical literature attributes persistently high rates of very low birthweight (VLBW) to “dysregulated” gestation. We offer the alternative view that natural selection conserved well-regulated, though nonconscious, decisional biology that protects the reproductive fitness of women by spontaneously aborting gestations that would otherwise yield frail infants, particularly small males. Modern obstetric practice, however, converts some fraction of these erstwhile spontaneous abortions into live births of very small infants. We further propose that the nonconscious decisional biology of gestation exhibits preferences also seen in consciously made decisions. We hypothesize that the incidence of VLBW among male infants should vary with the population's self-reported intentions to assume financial risk. We apply time-series modeling to monthly birth counts by sex and weight from the Swedish Medical Birth Registry between January 1993 and December 2010. We gauge risk aversion with monthly data from the Micro Index of the Swedish Consumer Tendency Survey (MISCT). Consistent with our argument that nonconscious decisional biology shares risk aversion with conscious decisions, we find that the incidence of VLBW among male infants in Sweden varies with the population's self-reported intentions to assume financial risk. We find increases above expected odds of a very low weight infant among males born 1 month after increases above expected levels of self-reported risk aversion in the Swedish population. We offer this finding as support for the argument that persistently high rates of VLBW arise, at least in part, from a combination of medical interventions and mechanisms conserved by natural selection to protect reproductive fitness. [Copyright &y& Elsevier]

Work time control may offer opportunities, but also implies risks for employee recovery, influenced by increased work-related ICT use and overtime work. However, this risk-opportunity tradeoff remains understudied. This study aimed to test two different models of associations between work time control, work-related ICT use, overtime work, and the need for recovery. These models were constructed based on data on office workers with flexible work arrangements. Cross-sectional data were obtained with questionnaires ( n = 2582) from employees in a Swedish multi-site organization. Regression models treated the three determinants of the need for recovery either as independent, or as linked in a causal sequence. The test of independent determinants confirmed that more work time control was associated with less need for recovery, whereas more ICT use and overtime work were associated with a higher need for recovery. In a test of serial mediation, more work time control contributed to a greater need for recovery through more ICT use and then more overtime work. Work time control also had a competitive, indirect effect through a negative association with overtime work. Our results suggest that work time control is beneficial for employee recovery, but may for some be associated with more work-related ICT use after regular working hours, thus increasing recovery needs. Policies that support work time control can promote recovery, but employers must attend to the risk of excessive use of ICT outside of regular working hours.

Scholarly literature claims that health declines in populations when optimism about investing in the future wanes. This claim leads us to describe collective optimism as a predictor of selection in utero. Based on the literature, we argue that the incidence of suicide gauges collective optimism in a population and therefore willingness to invest in the future. Using monthly data from Sweden for the years 1973-2016, we test the hypothesis that the incidence of suicide among women of child-bearing age correlates inversely with male twin births, an indicator of biological investment in high-risk gestations. We find that, as predicted by our theory, the incidence of suicide at month t varies inversely with the ratio of twin to singleton male births at month t + 3. Our results illustrate the likely sensitivity of selection in utero to change in the social environment and so the potential for viewing collective optimism as a component of public health infrastructure.

Male twin gestations exhibit higher incidence of fetal morbidity and mortality than singleton gestations. From an evolutionary perspective, the relatively high rates of infant and child mortality among male twins born into threatening environments reduce the fitness of these gestations, making them more vulnerable to fetal loss. Women do not perceive choosing to spontaneously abort gestations although the outcome may result from estimates, made without awareness, of the risks of continuing a pregnancy. Here, we examine whether the non-conscious decisional biology of gestation can be linked to conscious risk aversion. We test this speculation by measuring the association between household surveys in Sweden that gauge financial risk aversion in the population and the frequency of twins among live male births. We used time-series regression methods to estimate our suspected associations and Box-Jenkins modeling to ensure that autocorrelation did not confound the estimation or reduce its efficiency. We found, consistent with theory, that financial risk aversion in the population correlates inversely with the odds of a twin among Swedish males born two months later. The odds of a twin among males fell by approximately 3.5% two months after unexpectedly great risk aversion in the population. This work implies that shocks that affect population risk aversion carry implications for fetal loss in vulnerable twin pregnancies.