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Patients with bipolar disorder have higher rates of type 2 diabetes (T2D) compared to the general population. Neighbourhood deprivation is associated with T2D and bipolar disorder. The aim of this study was to explore the potential effect of neighbourhood deprivation on incident T2D in patients with bipolar disorder. This nationwide open cohort study (1997–2018) included adults in Sweden ≥20 years with bipolar disorder (90,780 patients) to examine the subsequent risk of T2D. The association between neighbourhood deprivation and T2D was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). All models were conducted in both men and women and adjusted for individual‐level sociodemographic factors and comorbidities. Neighbourhood deprivation was significantly associated with T2D in patients with bipolar disorder. The HRs were 1.61 (95% CI 1.40–1.86) for men and 1.83 (1.60–2.10) for women living in high deprivation neighbourhoods compared to those from low deprivation neighbourhoods. After adjustment, these results remained significant: 1.35 (1.17–1.56) in men and 1.39 (1.20–1.60) in women living in high deprivation neighbourhoods. The suggested graded association of higher incident T2D among patients with bipolar disorder, observed when levels of neighbourhood deprivation increased, raises important clinical and public health concerns. The results may help develop a contextual approach to prevention of T2D in patients with bipolar disorder that includes the neighbourhood environment. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to propose and assess a framework to analyse the institutionalization of Industry 4.0 (I4.0) through a framing analysis. Design/methodology/approach: The framework was developed by combining the institutional approach with orders of worth, drawing insights from a comprehensive literature review. To assess it, the authors conducted a qualitative analysis of annual reports from companies with the largest market capitalization over a six-year period and interviewed union representatives in Spain and Sweden. Findings: The framework comprises five dimensions (industrial, market, civic, green and connectionist). The empirical results reveal that companies consistently frame I4.0 with an emphasis on industrial and market perspectives. In contrast, unions place a stronger emphasis on civic issues, with Spanish unions holding a more negative view of I4.0, expressing concerns about working conditions and unemployment. Research limitations/implications: The proposed framework brings interesting insights into the dispute over the meaning of I4.0. Although this empirical study was limited to companies and unions in Sweden and Spain, the framework can be expanded for broader investigations, involving additional stakeholders in one or more countries. The discussion outlined using the varieties of capitalism approach is relevant for understanding the connection between the meso and macro levels of this phenomenon. Practical implications: In navigating the landscape of I4.0, managers should remain flexible, and ready to tailor their strategies and operations to align with the distinct demands and expectations of stakeholders and their specific institutional environments. Similarly, policymakers are urged to acknowledge these contextual intricacies when crafting strategies for implementing I4.0 initiatives across national settings. Social implications: Based on the empirical findings, this study underscores the importance of fostering social dialogue and involving stakeholders in the implementation of I4.0. Policymakers and other stakeholders should take proactive measures, tailored to each country's context, to mitigate potential adverse effects on labour and workers. Originality/value: The study presents a novel framework that facilitates the systematic comparison of I4.0 framing by different actors. This contribution is significant because the way actors frame I4.0 affects its interpretation and implementation. Additionally, the aggregate analysis of results enables cross-country comparisons, enhancing our understanding of regional disparities. [ABSTRACT FROM AUTHOR]

Social trust is a moral resource with a normatively highly desirable pay-off. Previous research argues that universal welfare state programmes 'make' social trust whereas means-testing programmes 'break' it. Despite its important implications for welfare-state design, comparative longitudinal evidence for this hypothesis is scarce. To test whether within-country changes in social trust are associated with within-country changes in total, means-tested, and non-means tested social protection expenditure, I thus merge country-year specific ESSPROS welfare spending data with cross-country survey data from 30 countries that participated in the 2002–2019 European Social Survey. Results from multilevel regression models show that neither within-country changes in total nor means-tested or non-means tested social protection expenditure predict social trust. Based on insights from the welfare deservingness literature, the second part of my analysis concentrates on welfare spending directed at two different life-course risks, with sickness representing a risk that the public widely considers to be 'deserving' of welfare support, and unemployment acting as an 'undeserving' risk. I find that, within countries over time, means-tested healthcare expenditures predict decreases in social trust, whereas non-means tested healthcare expenditure is associated with increasing social trust. My results thus lend support for the hypothesis that welfare-state selectivity and universality can contribute to the making and breaking of social trust, but only when interventions target life-course risks that the public considers 'deserving' of welfare state support. [ABSTRACT FROM AUTHOR]

Background Unemployment and work disability are common among individuals with non-affective psychotic disorders (NAPDs) but it is unknown whether rates differ among migrants and native-born individuals. The present study aimed to compare the risk of these outcomes during the first 5 years of illness in non-refugee migrants, refugees and native-born individuals with NAPDs in Sweden and Denmark—two countries with different immigration policies and models of early psychosis care. Methods Using national registers, we identified all individuals aged 18–35 years in Sweden and Denmark who received an incident NAPD diagnosis between 2006 and 2013 (N  = 6750 and 8320, respectively). Cohorts were followed for 5 years to determine the days of unemployment and sickness absence (analyzed using zero-inflated negative binomial models) and the time to receipt of disability pension (analyzed using complementary log-log models). Results Relative to their native-born peers, refugees and non-refugee migrants in Sweden and non-refugee migrants in Denmark were significantly less likely to have zero unemployment days (OR range: 0.54–0.72) and all migrant groups experienced more unemployment days (IRR range: 1.26–1.37). Results were largely unchanged after adjustment for sociodemographic and clinical factors. In the adjusted model, both Swedish migrant groups and refugees in Denmark were more likely to experience zero sickness absence days than native-born individuals (OR range: 1.48–1.56). Only refugees in Denmark were at greater risk of disability pension. Conclusions Non-refugee migrants and refugees with NAPDs in both Sweden and Denmark are particularly vulnerable to experiencing unemployment. Targeted interventions may help to reduce these disparities and promote long-term work ability among migrant groups. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic struck societies directly and indirectly, not just challenging population health but disrupting many aspects of life. Different effects of the spreading virus--and the measures to fight it--are reported and discussed in different scientific fora, with hard-to-compare methods and metrics from different traditions. While the pandemic struck some groups more than others, it is difficult to assess the comprehensive impact on social inequalities. This paper gauges social inequalities using individual-level administrative data for Sweden's entire population. We describe and analyze the relative risks for different social groups in four dimensions--gender, education, income, and world region of birth--to experience three types of COVID-19 incidence, as well as six additional negative life outcomes that reflect general health, access to medical care, and economic strain. During the pandemic, the overall population faced severe morbidity and mortality from COVID-19 and saw higher all-cause mortality, income losses and unemployment risks, as well as reduced access to medical care. These burdens fell more heavily on individuals with low income or education and on immigrants. Although these vulnerable groups experienced larger absolute risks of suffering the direct and indirect consequences of the pandemic, the relative risks in pandemic years (2020 and 2021) were conspicuously similar to those in prepandemic years (2016 to 2019). [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the association between watching pornography and poor mental health in three repeated cross-sectional surveys in Sweden (2004, 2009, 2014) among high school seniors (13,277 students) with an average age of 18 years. The same index questions concerning ever having watched pornography and the frequency of watching pornography during the last year were combined with three different measures of psychological health and background control variables in multiple logistic regression and forward stepwise logistic regression models. The repeated cross-sectional surveys did not find any consistent associations across years between poor mental health and ever having watched pornography or the frequency of watching pornography. Having watched deviant pornography (containing violence, children and/or animals) was associated with poor mental health among boys in two surveys but only in one survey among girls. Other characteristics, such as mother's unemployment (especially boys), parenting style (especially high controlling parents among boys) and experiences of sexual abuse (especially penetrating abuse among girls), were more consistently and strongly associated to poor mental health across the three surveys. This study stresses the importance of controlling for multiple background variables when studying the association between watching pornography and mental health, since the association might primarily be explained by underlying confounding variables. [ABSTRACT FROM AUTHOR]

Objectives: The aims of the study are to investigate trajectories of labor market marginalization (IMM) and to examine the associations between family-related life events and LMM trajectories while accounting for familial factors. Methods: This is a prospective cohOIt study of 37.867 Swedish twins. Data were mialyzed by group-based trajectory modeling. Associations of thmily-related life events with trajectory groups were estimated by multinomial logistic regression. Results: Most participants had no or low levels of LMM. Individuals who stayed niarried over time or changed from single without children to married with children had a decreased risk of LM M. The risk of LMM over time was higher among individuals who changed from married to being single. Conclusions: Being or getting married as well as having children decreases the risk of LMM while divorce is a risk factor for LIV[M. [ABSTRACT FROM AUTHOR]

Background Residential regions may impact the possibilities to achieve a sustainable working life (SWL, i.e. not having interruptions due to sickness absence, disability pension or unemployment) due to disparities in social security and labour market. We aimed to investigate concurrent trajectories of regions and SWL among Swedish twins. Methods National register data were used for the degree of SWL in each year, old-age pension, emigration, death and residential regions classified in three categories (cities; towns and suburbs; or rural areas) of Swedish twins in 1998–2016 (n  = 80 398). Group-based multi-trajectory modelling and multinomial regression for relative risks with 95% confidence intervals were calculated. Results The six-group solution had the best fit to data with trajectories: stable living in towns and suburbs with SWL (33.8%); stable living in cities with SWL (22.1%); stable living in towns and suburbs with increasing SWL (13.9%); stable living in towns and suburbs with lack of SWL (13.2%); stable living towns and suburbs with decreasing SWL (8.8%); and stable living towns and suburbs with decreasing and ultimately lack of SWL (8.3%). Age and being woman increased and being married and higher education decreased the likelihood of belonging to groups 2–6 (vs. 1). Conclusions The simultaneous assessment of trajectories of three residential regions and SWL indicated that most people in Sweden seem to live continuously over time in towns and suburbs, but the degree of SWL may vary. More fine-grained assessment of residential regions would be needed to clarify the associations with SWL. [ABSTRACT FROM AUTHOR]

Aims: We investigated if the risk of long-term unemployment (LTU) and disability pension (DP) differs between young refugees and non-refuge immigrants compared to the Swedish-born. The role of age at arrival, duration of residency and morbidity in this association was also investigated. Methods: All 19- to 25-year-olds residing in Sweden on 31 December 2004 (1691 refugees who were unaccompanied by a parent at arrival, 24,697 accompanied refugees, 18,762 non-refugee immigrants and 621,455 Swedish-born individuals) were followed from 2005 to 2016 regarding LTU (>180 days annually) and DP using nationwide register data. Cox regression models were used to estimate crude and multivariate-adjusted (adjusted for several socio-demographic, labour market and health-related covariates) hazard ratios (aHRs) with 95% confidence intervals. Results: Compared to the Swedish-born, all migrant groups had around a 1.8-fold higher risk of LTU (range aHR=1.71–1.83) and around a 30% lower risk of DP (range aHR=0.66–0.76). Older age at arrival was associated with a higher risk of LTU only for non-refugee immigrants. Both older age at arrival and a shorter duration of residency were associated with a lower risk of DP for all migrant groups. Psychiatric morbidity had the strongest effect on subsequent DP, with no significant differences between migrant groups and the Swedish-born (range aHR=5.1–6.1). Conclusions: Young immigrants had a higher risk of LTU and a lower risk of DP than their Swedish-born peers. No differences between the different immigrant groups were found. Age at arrival, psychiatric morbidity and duration of residency are strong determinants of being granted DP. [ABSTRACT FROM AUTHOR]

Background The present study examined the independent and combined effects of childhood adversity (CA) and occupational class on the risk of future labor market marginalization (LMM) in young employees in Sweden. Occupational class (non-manual/manual workers) was also explored as a potential mediator. Methods This population-based longitudinal cohort study included 556 793 employees, 19–29 years, residing in Sweden in 2009. CAs included parental death, parental mental and somatic disorders, parental separation, household public assistance, single-parent household and residential instability. Measures of LMM included long-term unemployment (LTU), long-term sickness absence (LTSA) and disability pension. Estimates of risk of each LMM measure, between 2010 and 2016 were calculated as hazard ratios (HRs) with 95% confidence intervals (CIs), using a Cox regression analysis. Results Those exposed to CA had an elevated risk for all measures of LMM. Manual workers with a history of household public assistance had the highest risk estimates compared to non-manual workers with no CAs [adjusted HR spanning from 1.59 (LTSA) to 2.50 (LTU)]. Regardless of occupational class, the risk of LMM grew higher with increasing number of CAs (e.g. adjusted HR of LMM in manual workers with 3+ CAs: 1.87, 95% CI: 1.81–1.94). These patterns persisted after adjustments for a range of confounders, including psychiatric and somatic morbidity. Last, we found a small but significant mediating effect of occupational class in the association between CA and LMM. Conclusions Information on CAs are important determinants of LMM in young adults, and especially in manual workers. [ABSTRACT FROM AUTHOR]

Background: The objective of this population-based register study was (1) to investigate the association between young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and subsequent labour market marginalisation (LMM) in two comparison groups, i.e. matched young adults from the general population without ADHD and unaffected siblings to persons with ADHD and (2) to assess the role of comorbid disorders. Methods: This study included all young adults in Sweden, aged 19–29 years, with an incident diagnosis of ADHD 2006–2011 (n = 9718). Crude and multivariate sex-stratified hazard ratios (HRs) with 95% confidence intervals (CIs) were measured 5 years after the diagnosis of ADHD for the risk of disability pension, long-term sickness absence (SA) (>90 days), long-term unemployment (>180 days) and a combined measure of all three in young adults with ADHD compared to their siblings without ADHD and a matched comparison group. Results: In the adjusted analyses young adults with ADHD had a 10-fold higher risk of disability pension (HR = 10.2; CI 9.3–11.2), a nearly three-fold higher risk of long-term SA (HR = 2.7; CI 2.5–2.8) and a 70% higher risk of long-term unemployment (HR = 1.7; CI 1.6–1.8) compared to the matched comparison group. The risk estimates were lower compared to siblings for disability pension (HR = 9.0; CI 6.6–12.3) and long-term SA (HR = 2.5; CI 2.1–3.1) but higher in the long-term unemployed (HR = 1.9; CI 1.6–2.1). Comorbid disorders explained about one-third of the association between ADHD and disability pension, but less regarding SA and long-term unemployment. Conclusions: Young adults with ADHD have a high risk for different measures of LMM and comorbidities explain only a small proportion of this relationship. [ABSTRACT FROM AUTHOR]

Background A growing literature finds that adult mental health worsens during economic downturns. Current insights on the relationship between macroeconomic fluctuations and psychotropic medication are based on self-reported information or aggregate measures on prescriptions. This study assesses the relationship between local macroeconomic conditions and individual use of psychotropic medication as reported in administrative registers. Methods We use local information on unemployment linked to individual-level longitudinal data on detailed psychotropic drug consumption from administrative registers, for individuals in working age (20–65) in Sweden 2006–13. Any psychotropic medication uptake and the related number of redeemed prescriptions are the primary outcomes. Mortality is considered a secondary outcome. Results Among young men (aged 20–44) and older women (aged 45–65), we find reduced use of psychotropic medication (2–4% compared to the mean) when the local labor market conditions deteriorate. The relationship is driven by reduced use of antidepressants. The same age-gender groups experience a significantly higher risk of mortality in bad times. Conclusions This study shows that economic downturns may not only put strain on individuals' mental health but also on their access to psychopharmaceutic treatments. [ABSTRACT FROM AUTHOR]

Background Changes in Swedish national insurance policies over time and/or migration-related health inequalities may influence the risk for labour market marginalization (LMM) in refugees as compared to the Swedish-born host population. This study aimed to investigate potential period effects in the association between refugee status and the risk of LMM and explore any differences by country of birth, age and duration of residence. Methods Using national registers, three cohorts including all Swedish residents during 1999, 2004 and 2009 were followed for 4 years (cohort 2000, 2005 and 2010). Cox regression models were used to examine associations between refugee status and LMM defined as long-term unemployment (>180 days annually) and disability pension. The analyses were adjusted for socio-demographic factors, morbidities and labour market-related factors. Stratified analyses were run for age, country of birth and duration of residence. Results Across the cohorts, hazard ratios (HRs) were higher for long-term unemployment [2000: HR = 1.98; 95% confidence interval (CI): 1.96–2.01; 2005: HR = 2.30; 95% CI: 2.27–2.33; 2010: HR = 2.78; 95% CI: 2.75–2.81] for refugees compared to Swedish-born but not for disability pension. HRs for long-term unemployment were highest among refugees aged 25–34 and 35–44 years, from Somalia, Afghanistan and Iraq and refugees with a shorter duration of residence. Conclusions The risk of long-term unemployment appears to have increased for refugees over time. Particularly some refugee subgroups experienced more difficulties. These findings highlight ongoing disparities for refugees and implicate on a broader scale that changes in policies such as stricter regulations in the insurance or healthcare system might adversely affect them. [ABSTRACT FROM AUTHOR]

Evaluate feasibility, partnerships, and study design of intervention to minimise sick leave. The design was a pilot single arm intervention study in primary health care. Outcome measures at follow-ups for each participant were compared with baseline data for the same person. Twenty primary health care patients with recurrent or long-term sick leave or health-related unemployment. Patient education through interactive study groups that met half a day a week for eight subsequent weeks. Groups were led by experienced but not medically trained facilitators. The intervention was designed to improve participant health literacy, sense of coherence, health-related quality of life, and patient involvement in healthcare. Primary outcome was the level of sick leave. Sick leave data were obtained from medical records when available, otherwise patient reported. Secondary outcomes regarding health literacy, sense of coherence, and health-related quality of life were measured with validated questionnaires at baseline and follow-ups. Level of sick leave decreased significantly and participation in work preparatory activities increased during follow-up. Health literacy, sense of coherence (subscale sense of meaningfulness), and health-related quality of life (subscale social functioning) showed statistically significant improvement. Intervention, partnerships, and study design were feasible. An educational programme, conducted in cooperation between primary health care and partners outside the healthcare system, was feasible and showed an impact on sick leave, health literacy, sense of coherence, and health-related quality of life. A pilot study to evaluate an educational programme with study groups conducted in cooperation between primary health care and partners outside the healthcare system showed good feasibility. Sick leave decreased significantly six months after baseline. Health literacy, sense of coherence (subscale sense of meaningfulness), and health-related quality of life (subscale social function) improved significantly 6 months after baseline. [ABSTRACT FROM AUTHOR]

This article reports on a reality TV series, Sweden's best employment service, broadcast on Swedish public service television in 2018. The purpose was to investigate ongoing political transformations in the Swedish welfare model. The series focuses not only on unemployment, the unemployed and their life situation but more specifically on the organisation of the Swedish Public Employment Service (PES) as reflected at a local PES office. Informed by a cultural studies approach to the politics of popular culture, the aim of this article is to examine how the makeover is staged in the series. The article focuses on how the unemployed are positioned in the series in a setting of organisational change initiated at the local PES office. The analysis provides insights into how the makeover is staged and initiated in reality TV and illustrates how the unemployed are positioned as willing and able to work and to actively seek opportunities. The unemployed are not the primary target for the makeover in the series. The makeover is primarily directed at the organisation of the PES and its managers. Consequently, unemployment is presented in the series as not only a concern for the individual citizen but also for society. Nine o'clock on channel sixGet the beer and get the chipsDeath is live upon the screenIt's reality TV!Tankard, R.T.V., 1994 [ABSTRACT FROM AUTHOR]

The clustering of social disadvantage with attention‐deficit/hyperactivity disorder (ADHD) in young adulthood is not well understood. We examined the clustering of ADHD with low educational attainment and unemployment in young adulthood; whether such clustering is stronger when unemployment is prolonged; and whether further clustering of disability pensioning, low education and unemployment occurs among those with ADHD. Data were obtained from Swedish health, demographic and social security registers from which 8,990 individuals with recorded ADHD diagnoses at the age of 10–35 and their 44,387 matched referents without mental disorders. Social disadvantage was measured using data on educational attainment, unemployment and disability pension from the diagnosis year or age 19 if diagnosed at younger age. Clustering was examined by comparing observed and expected occurrence (O/E ratio) of all possible combinations of ADHD, low education and unemployment, and, among those with ADHD, additional combinations with new‐onset disability pension. The likelihood of having neither ADHD, low education nor unemployment was increased (O/E ratio = 1.20, 95% confidence interval 1.19–1.20 at baseline; 1.18, 1.17–1.18 at follow‐up), as well as having all three characteristics (O/E ratio = 3.99, 3.89–4.10 at baseline; 5.68, 5.47–5.89 at follow‐up). This clustering was stronger among women than men and when unemployment was prolonged. The results suggest that low education and unemployment appear to cluster remarkably with ADHD among young adults, more so among women and when unemployment is prolonged. [ABSTRACT FROM AUTHOR]

In many European countries, a growing share of population with immigrant background coincides with the surge in support for radical right parties. In this paper we show how such increases affect radical right candidacy. We use Swedish register data which identifies political candidates. With geocoded data, we match individuals running for the Sweden Democrats to their local neighbourhood contexts, and measure changes in the share of visible minority residents at scales ranging from 100 meters to 2 kilometres. For those who stayed in the same neighbourhood between 2006 and 2010, the change in the share of visible minorities generally does not affect the decision to join the pool of party candidates. This result is robust when we introduce additional tests and select on the scale of the neighbourhood, unemployment terciles, change in share of visible minority groups terciles, and entry threshold into the pool of candidates. For those who stayed in the same neighbourhood, the only significant finding is a small mobilisation effect for a subsample of individuals who live in densely populated metropolitan neighbourhoods – here we also observe a halo effect, with negative association for small-scale changes and positive association for changes in the larger halo zone. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has contributed to unprecedented worries and challenges for pregnant women due to social restrictions and changes in maternity care provision. We aimed to investigate the mental health impact of COVID-19 pandemic on pregnant women in Sweden and explore factors associated with poor perinatal mental health in this specific context.Method: This was a nation-wide cross-sectional survey of pregnant women living in Sweden. Validated questionnaires were distributed through non-profit organizations´ websites and social media channels from May 2020 to February 2021. Perinatal depression, anxiety, and acute stress reaction were assessed using the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder-7 (GAD-7) and Impact Event Scale (Revised) (IES-R), respectively. Sociodemographic characteristics and self-perceived mental well-being were also obtained. Factors associated with mental health outcomes were analyzed using multivariate logistic regression model.Results: Among a total of 470 participants, 43.2% (n = 203) reported depression (EPDS ≥13), 25.7% (n = 121) moderate to severe anxiety (GAD-7 score ≥ 10), and 23.7% (n = 110) moderate to severe acute stress reaction (IES-R ≥ 33). 27.4% participants (n = 129) expressed concerns regarding their mental well-being during the pandemic. Pregnant mothers who had sick family members reported poorer mental health outcomes than those who did not (median [Interquartile range (IQR)] EPDS scores: 14.0 [8.75-18.0] vs 11.0 [6.25-15.0], p < .001; median (IQR) GAD7 scores: 7.0 [4.0-12.25] vs 6.0 [3.0-9.0], p = .003); median (IQR) IES-R scores: 20.0 [9.0-38.0] vs 15.0 [7.0-30.0], p = .048). Logistic regression analyses revealed that risk factors for poor mental health outcomes were having a sick family member with any illness, unemployment, and experiencing a substantially stressful life event. Having a higher educational level and a younger age during the pandemic were protective.Conclusion: Depression and anxiety were highly prevalent among pregnant women in Sweden during the COVID-19 pandemic, indicating a need for professional mental health support for this vulnerable group of population. Unemployment was an associated risk factor whereas younger age and higher educational level were protective suggesting an important role of socio-economic factors in modulating the impact of COVID-19 pandemic on perinatal mental health. [ABSTRACT FROM AUTHOR]

Health literature shows that unemployment has a gendered effect on health. However, whether men or women are more affected and why remains unclear. We assume that unemployment harms women less than men because of two mechanisms: social roles theories and health selection. First, the availability and centrality in individuals' lives of roles other than employment may reduce the detrimental effect of unemployment for women. Second, the gendered impact of unemployment on health results from the different ways selection mechanisms operate across genders. Moreover, these two mechanisms may operate differently in different contexts – for example, across different gender regimes. We investigate this by pursuing a three‐step comparative approach. The analysis relies on EU‐SILC data covering Italy and Sweden for 2004 to 2015 and SOEP data for Germany (1995–2017) and applies correlated dynamic random‐effects probit models. While we find weak support for the role of health selection in shaping the relations between unemployment, health, and gender, our empirical results are in line with the hypothesis of a larger gendered effect in older (vs younger) cohorts, western (vs eastern) Germany and Italy (vs. Sweden). Future empirical research needs to directly address the role of gender regimes in moderating such complex relationships. [ABSTRACT FROM AUTHOR]

This paper studies the effects of economic distress on support for radical right parties. Using Swedish election data, I show that one layoff notice among low-skilled native-born workers increases, on average, support for the Swedish radical right party the Sweden Democrats by 0.17–0.45 votes. The relationship between layoff notices and support for the Sweden Democrats is stronger in areas with a high share of low-skilled immigrants and in areas with a low share of high-skilled immigrants. These findings are in line with theories suggesting that economically distressed voters oppose immigration as they fear increased labor market competition. In addition, I use individual-level survey data to show that self-reported unemployment risk is positively associated with voting for the Sweden Democrats among low-skilled respondents while the opposite is true for high-skilled respondents, echoing the aggregate-level findings. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have reported an elevated risk of sickness absence (SA) and disability pension (DP) due to adverse psychosocial working conditions, yet the influence of age and familial factors on the associations have not been examined. We aimed to investigate associations between psychosocial working conditions and labour market marginalisation (LMM) in terms of unemployment, SA and DP adjusting for familial confounding and possible differences in these associations with different age groups and different unemployment and sick leave days. Methods: All twins living in Sweden in 2001, aged 16–64 years and not on old-age pension or DP were included (n = 56,867). The twins were followed from 2002 to 2016 regarding unemployment, SA and DP. Cox proportional hazards regression models were performed for the whole sample, and for discordant twin pairs, in five age groups. Results: Each one-unit increase in job demands and job control was associated with a lower risk of unemployment, SA and DP in all age groups. Moreover, each one-unit increase in social support was associated with an increased risk of 1–30 days unemployment in individuals older than 45 years and SA and DP. Social support decreased the risk of unemployment longer than 365 days in age groups 16–25 and 36–45 years. In the discordant twin pair analyses, the estimates attenuated towards statistical non-significance. Conclusion: Even though familial factors seem to influence the associations between psychosocial working conditions and LMM, improving psychosocial working conditions by for example promoting high job control and social support at workplace may reduce the risk of future short- and long-term LMM in all age groups. [ABSTRACT FROM AUTHOR]

The Addiction Severity Index (ASI) assesses respondents' biopsychosocial problems in seven addiction-related domains (mental health, family and social relations, employment, alcohol use, drug use, physical health, and legal problems). This study examined the association between the seven ASI composite scores and re-employment in a sample of Swedish adults screened for risky alcohol and drug use who were without employment at assessment. We conducted a retrospective cohort analysis of employment outcomes among 6502 unemployed adults living in Sweden who completed an ASI assessment for risky alcohol and drug use. The study linked ASI scores to annual tax register data. The primary outcome was employment, defined as having earnings above an administrative threshold. We used Cox proportional hazard models to estimate the association between time to re-employment and ASI composite scores, controlling for demographic characteristics, Approximately three in ten individuals in the sample regained employment within five years. ASI composite scores suggested widespread biopsychosocial problems. Re -employment was associated with lower ASI composite scores for mental health (estimate: 0.775, 95 % confidence interval: 0.629–0.956), employment (estimate: 0.669, confidence interval: 0.532–0.841), drug use (estimate: 0.628, confidence interval: 0.428–0.924), and health (estimate: 0.798, confidence interval: 0.699–0.912). This study suggests that several ASI domains may provide information on the complex factors (i.e., mental health, health, drug use) associated with long-term unemployment for people with risky substance use. • Swedish adults are routinely assessed for substance use while unemployed. • Seven out of ten remain without work for at least five years. • Health, mental health, and drug, and legal problems are widespread among them. • Mental health, alcohol and health problems correlated with lower re-employment. [ABSTRACT FROM AUTHOR]

The conceptualisation and measurement of benefit coverage is muddled with considerable confusion. In this forum contribution, we propose a new consolidated framework for the analysis of benefit coverage. Three sequential steps in measurement are suggested, involving the calculation of coverage rates, eligibility rates and take-up rates in social protection. Each step of the analysis focuses on particular aspects of programme legislation and implementation, and together the new framework will substantially improve the possibilities of research to inform policymaking. We provide an empirical illustration of our approach based on Swedish data, and highlight how our new consolidated framework for analysing benefit coverage provides a reorientation of the research agenda on benefit coverage. [ABSTRACT FROM AUTHOR]

Previous research suggests that young adults from out‐of‐home care (OHC) are at high risk of low education and unemployment. However, there are no studies on their risk of long‐term NEET (Not in Employment, Education or Training). This study compared the risk of NEET at age 21–23 among OHC youth across Denmark, Finland and Sweden, using register data for an entire birth cohort born in 1987. The Nordic countries share many features, but there are differences in the provision of after‐care support and in the linkage between the educational system and the labour market. The results show that about a fourth in Denmark and Sweden and a third in Finland were NEET, suggesting that the welfare systems were not able to compensate for the OHC youth's childhood disadvantages. To a significant extent, the excess risk of NEET was attributed to poor school performance. Implications for research, policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Background and aims: Interventions to suppress the coronavirus pandemic have led to economic recession and higher unemployment, which will increase mortality and decrease quality of life. The aim of this article is to estimate the consequences on mortality and life expectancy of increased unemployment rates due to the coronavirus pandemic in Sweden and other countries. Methods: Based on recent increases and expected future unemployment rates due to the coronavirus pandemic, results from a systematic review and data from vital statistics in Sweden, the number of premature deaths due to unemployment in Sweden have been estimated. Results: Based on our assumptions, the calculations show that if the number of unemployed persons in Sweden increases by 100,000, one may expect some 1800 more premature deaths during the following 9 years. If the duration of the recession is limited to 4 years, excess deaths due to unemployment may be around 800. On average, the unemployed will lose 2 years of their remaining life expectancy. In many other countries unemployment rates have or are estimated to rise more than in Sweden, sometimes two- or threefold, suggesting hundreds of thousands of excess deaths due to unemployment. Conclusions: Interventions to suppress the coronavirus pandemic include the shut-down of economic activities and lead to increased all-cause mortality. These public health effects must be considered in the decision-making process and should be added to overall estimates of the effects of the pandemic on public health. [ABSTRACT FROM AUTHOR]

Unemployment insurance systems are designed to provide income security for those who drop out of work temporarily. This form of social protection is particularly relevant for foreign-born workers who are, on average, more likely to become unemployed during layoffs. The article explores how the social protection of immigrants differs in cases where payments are tied to voluntary rather than mandatory contributions. This is done by focusing on a recent welfare reform in Sweden which led to both a sharp increase in costs and a decline in benefit generosity overnight. It is argued that migrants lost their social protection at a disproportionate rate over the course of the reform. Both their status on the labour market and position as newcomers to the norms and rules of society are expected to impede on their decision to obtain or prolong insurance membership, leading to a decline in eligibility to income security. Difference-in-difference estimates with administrative data from all unemployment insurance funds show that the share of benefit recipients with earnings-related payments decreased at a higher rate among the foreign-born as expected, especially if they had arrived in the country only recently. [ABSTRACT FROM AUTHOR]

Active labour market policies (ALMPs) are widely diffused measures aiming to re-integrate jobseekers into the labour market. Despite their crucial role in acting as gatekeepers to employment, the literature scarcely considers the employer's perspective of these measures. We analysed whether and how employers consider ALMP participation in the hiring process as a signal that helps explain the labour market outcomes of jobseekers. We developed a theoretical argument regarding how employers interpret ALMP participation and identify assumed agency, that is, whether employers believe that the agency for initiating ALMP participation lies with the jobseeker (voluntary participation) or the job centre (mandatory participation), as a crucial factor determining whether their evaluation of ALMPs is positive or negative. To examine our expectations, we conducted qualitative interviews with employers hiring for low-skilled occupations in Switzerland and Sweden, representing two countries with comprehensive ALMP systems. As expected, the interpretation of ALMP programmes differs depending on the assumed agency. Employers who believe that participation is voluntary interpret participation as a signal of motivation; however, employers who believe that participation is mandatory interpret participation as a signal of lower productivity, which reduces the chances of a successful labour market access. [ABSTRACT FROM AUTHOR]

Aims. To investigate demographics and socioeconomic status in patients with ulnar nerve compression and the influence of socioeconomic factors on patient-reported outcome measurements (PROM) as evaluated by QuickDASH (short version of Disabilities of Arm, Shoulder and Hand) after surgery for ulnar nerve compression at the elbow. Methods. Patients operated for primary ulnar nerve compression from 2010 to 2016 were identified in the National Quality Registry for Hand Surgery Procedures (HAKIR). Patients filled out questionnaires before and at three and 12 months after surgery. A total of 1346 surgically treated cases were included. Data from HAKIR were linked to data from Statistics Sweden (SCB) on socioeconomic status (i.e., education level, earnings, social assistance, immigrant status, sick leave, unemployment, and marital status). Results. Patients surgically treated for ulnar nerve compression at the elbow differed from the general population with lower levels of education, higher social assistance dependence, a high proportion of unemployment, and lower earnings. However, the results were not clear concerning the influence of socioeconomic factors on the outcome of surgery, except for long-term sick leave. Conclusion. Patients surgically treated for ulnar nerve compression at the elbow are socioeconomically deprived, but only a history of long-term sick leave influences the outcome of surgery. This information is crucial in the diagnosis and treatment of these patients. [ABSTRACT FROM AUTHOR]

A recent policy reform in Sweden reorganized the management of newly arrived migrants' entrance into the labour market, which resulted in the Swedish Public Employment Service being given coordinating responsibility and introducing private service providers. Building on qualitative interviews with public employment officers and private actors, this study focuses on how the political contradictions in the new 2‐year introduction programme are managed at the organizational level. In the article, it is argued that although both public employment officers and private actors experience difficulty separating unemployed migrants' need for social support from the workfare ambitions of the programme, aspects of privatization—such as freedom of choice and the service specification—further complicate this situation. Thus, the individualization aspects of the policy should be viewed as countering some of the more controlling aspects of the reform, thus, in effect, neutralizing its liberalizing tendencies. [ABSTRACT FROM AUTHOR]

Aims: To investigate to what extent socioeconomic differences in swimming abilities persist among children in the city of Malmö, Sweden, after a community-level swimming intervention programme in public primary schools. Methods: A compulsory swimming education programme was launched in 2014 in second grade (at age 8) in all public primary schools in Malmö, Sweden. Data for the present study on sociodemographic conditions and self-reported swimming ability in fourth grade (age 10) were used for the last birth cohort unexposed (n = 1695) and the first birth cohort exposed (n = 1773) to the intervention. Results: The swimming ability was 78 and 77%, respectively, in the pre- and post-intervention cohorts. Significantly lower self-reported swimming ability was found both pre- and post-intervention among children with support activities in school, with parents born outside Europe, North America and Australia, with manual working, unemployed or studying parents and in children enrolled in schools with socioeconomic index below median. Conclusions : The findings do not suggest that sociodemographic differences in swimming ability have decreased in the first birth cohort exposed to the community-level intervention in Malmö. Striking differences in self-reported swimming ability were noted when the children reached the fourth grade both pre- and post-intervention with marked lower abilities in socially disadvantaged groups. Monitoring of swimming abilities should continue for the present, and similar interventions aimed at reducing inequalities among children. Efforts to increase water comfort at preschool age ought to be considered. [ABSTRACT FROM AUTHOR]

Objectives: Investigate prospective associations between combinations of job demands/job control and future labor market situation. Methods: A population-based prospective cohort study of 2,194,694 individuals in paid work. Using multinomial logistic regression, we calculated the association between combinations of job demands/control in 2001, according to a job exposure matrix, and their long-term unemployment, sickness absence/ disability pension, early old-age pension, emigration, and death in 2012. Results: Low demands/low control at baseline was associated with longterm sickness absence/disability pension at follow-up among both women and men (odds ratios [ORs] 1.49; 95% confidence intervals [CIs] 1.46-1.53). High demands/low control at baseline was associated with a higher likelihood of old-age pension among women (OR 1.91; Cl 1.82-2.00). and with a lower likelihood among men (OR 0.59; Cl 0.53-0.66). Conclusions: Combinations of job demands/job control in 2001 were associated with labor market situation in 2012. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the role of refugee status and specific mental disorders regarding subsequent labour market marginalisation.Methods: Prospective cohort study of all refugees (n = 216,930) and Swedish-borns (n = 3,841,788), aged 19-60 years, and resident in Sweden in 2009. Hazard ratios (HRs) with 95% Confidence Intervals (CIs)  for long-term unemployment (> 180 days) and disability pension (DP) were calculated with Cox regression analyses.Results: Mental disorders were more prevalent in refugees compared to Swedish-born individuals, with greatest differences seen for post-traumatic stress disorder (PTSD; refugees 1.3%; Swedish-born individuals 0.1%). Regarding long-term unemployment, refugees without a mental disorder had an adjusted HR (aHR) of 2.68 (95% CI 2.65-2.71) compared to Swedish-born individuals without mental disorders, which was above the aHR of refugees (aHR 2.33, 95% CI 2.29-2.38) and Swedish-born individuals (aHR 1.44, 95% CI 1.43-1.45) with mental disorders. Regarding DP, compared to Swedish-born individuals without mental disorders, the aHRs were 1.44 (95% CI 1.34-1.54) for refugees without, but 6.11 (95% CI 5.84-6.39) for refugees with mental disorders. Swedish-born individuals with mental disorder had an aHR of 3.96 (95% CI 3.85-4.07). With regard to specific disorders, the aHRs for refugees, as compared to Swedish-born individuals without mental disorders, were markedly increased for all disorders (e.g. PTSD: long-term unemployment aHR: 2.03 (95% CI 1.89-2.18); DP 7.07 (95% CI 6.42-7.78).Conclusion: Mental disorders are more prevalent in refugees than in Swedish-born individuals but do not appear to increase their risk of long-term unemployment. Refugee status and mental disorders strongly contribute to the risk of DP, indicating that factors beyond medical considerations contribute to their granting of DP. [ABSTRACT FROM AUTHOR]

Background: A maintained psychological wellbeing is important in order to continue working longer and remain active into older age. However, little is known about impact of different organizational factors, such as downsizing, on the mental health of older workers exiting the labor market. The aim in this study was to investigate trajectories of purchases of psychotropic drugs in relation to labor market exit later in life in a context with and without downsizing.Method: People living in Sweden, born 1941-1951, exiting paid work via unemployment, sickness absence/disability pension, or old-age pension were followed from 2005 to 2013 regarding purchases of psychotropic drugs. Individuals employed at a workplace closing down or downsizing with ≥18% between two subsequent years were compared to employees exiting from workplaces without downsizing or workplace closure. Generalized estimating equations was applied to derive trajectories of annual prevalence of purchased antidepressants, sedatives and anxiolytics from 4 years before to 4 years after a labour market exit.Results: During the period around the exit, old-age retirees experiencing a downsizing/workplace closure did not decrease their purchases of sedatives (OR 1.01 95% CI 0.95-1.07) while the unexposed decreased their purchases during this period (OR 0.95 95% CI 0.92-0.98). Similar differences concerning sedatives and antidepressants between exposed and unexposed were seen for those exiting via sickness absence or disability pension. Furthermore, a significant difference in purchases of anxiolytics was observed between those exposed to downsizing (OR 1.10 95% CI 0.97-1.24) and the unexposed (OR 0.98 95% CI 0.91-1.06) exiting via old-age retirement during the time before the exit.Conclusion: Downsizing or workplace closure, although weakly, was associated with higher prevalence of psychotropic drugs certain years around the labor market exit. The results support the idea that involuntary labor market exit in mature adulthood may negatively affect the development of mental health. [ABSTRACT FROM AUTHOR]

Background: Several components of the Swedish alcohol policy, e.g., pricing and availability, weakened when Sweden joined the EU in 1995. To counteract the possible negative effects of this, emphasis was placed on the local level as an important arena of alcohol prevention. Thus, considerable efforts were made to strengthen alcohol prevention in Swedish municipalities. Objectives: The aim of this study was to examine whether local alcohol prevention reduced consumption and alcohol-related harm in Swedish municipalities. Methods: Alcohol prevention was monitored using a composite measure called the Alcohol Prevention Magnitude Measure (APMM), with subcategories of staff and budget, inspections and licenses, policy, activities, and cooperation. APMM and its categories were analysed in relation to alcohol consumption and harm over time, 2006–2014. A fixed effects model was used with 63% (N=182, consumption) and 71% (N=207, harm) of 290 Swedish municipalities, respectively, included in the analyses. Results: The main results suggest that when APMM increases with 1 percent, the alcohol-related mortality decreases with 0.26 percent, controlled for changes in population size, median income, unemployment, and post-secondary education. In light of this result, the estimated effect of APMM on alcohol consumption (sales) is small (0.02 percent decrease); possible explanations for this are discussed in the article. Conclusion: The overall results indicate that local alcohol prevention initiatives in Sweden have reduced some forms of alcohol-related harm, not least alcohol-related mortality, during the period 2006–2014. Further studies are needed to assess the generalizability of the present study. [ABSTRACT FROM AUTHOR]

Background: Knowledge is needed on associations between job demands and job control and long-term sickness absence (SA) and unemployment. We explored associations of job demands and job control with SA/disability pension (DP) and unemployment among women and men in paid work. Methods : We included all 2,194,694 individuals living in Sweden in 2001, aged 30–54 years, and in paid work. The Swedish Job Exposure Matrix (JEM) was used to ascertain levels of job demands and job control. Individuals were categorized into nine groups based on combinations of high, medium, or low values on both demands and control. Using multinomial logistic regression, we estimated odds ratios (OR) with 95% confidence intervals (CI) for the association of job demands and job control with risk of long-term SA/DP (>183 net days) and long-term unemployment (>183 days). Results : Regarding SA/DP, among women the risk was highest for those in occupations with low demands and low control (OR=1.32; 95% CI: 1.28–1.36), whereas among men the risk was highest among those in occupations with high demands and low control (OR=1.22; 1.11–1.34). Regarding unemployment, among women the risk was highest among those in occupations with low demands and medium control (OR=1.30; 1.24–1.37), whereas among men the risk was highest for those in occupations with low demands and high control (OR=1.54; 1.46–1.62). Conclusions : Using a JEM among all in a population rather than for specific occupations gives a more comprehensive view of the associations between job demands/job control and long-term SA/DP and unemployment, respectively. [ABSTRACT FROM AUTHOR]

Background: Chronic musculoskeletal pain affects over 20% of the adult population and is one of the most common reasons for sick leave in Sweden. The aim of this study was to investigate which demographic, health and psychosocial work environment factors are of importance for a lower risk of future work disability and unemployment among workers with low back pain (LBP) and/or neck shoulder pain (NSP), and if familial factors influence these associations.Methods: All 5556 persons that reported having LBP and/or NSP in a web-based questionnaire study in 2004-2006 were included. They were followed up for work disability (sick leave > 90 days or disability pension), and unemployment (> 180 days in a year) until 31 December 2013. Hazard ratios (HR) with 95% confidence intervals were calculated using cox proportional hazard models of the whole sample, adjusting for covariates. In addition, co-twin analyses of outcome discordant twin pairs were conducted to assess the impact of familial confounding on the associations.Results: Being male, 19-28 years old, having higher education, only NSP, no history of depression or anxiety, good self-rated health, low job demands and high job control were associated with a lower risk of work disability (adjusted HR ranging between 0.29-0.85). No history of anxiety and depression and high job control was associated with a lower risk of unemployment (adjusted HR ranging from 0.53 and 0.67). Familial factors were found to affect the association between education and work disability, but none of the other associations investigated.Conclusions: Among those with LBP or NSP, good health in terms of mental- and self-rated health, few pain sites, as well as good psychosocial working conditions seem to indicate a lower risk for work disability. [ABSTRACT FROM AUTHOR]

Background The aims were to elucidate if trajectories of labour market marginalization (LMM), measured as sickness absence (SA)/disability pension (DP) or unemployment, differed between young immigrants and natives before and after an incident diagnosis of a common mental disorder (CMD), and to investigate if educational level, psychiatric comorbidity and duration of residence in Sweden (in immigrants) had different associations with subsequent LMM in natives compared with immigrants. Methods A total of 28 971 young adults (19–30 years), with an incident CMD (inpatient or specialized outpatient healthcare due to CMDs or dispensed prescribed antidepressants during 2007) were included. Group-based trajectory models were utilized to identify trajectories of annual months of LMM 3 years before and 6 years after the diagnosis. The associations of risk factors with different trajectories were investigated by multinomial logistic regression, χ2-test and Nagelkerke R 2 to measure the associations' strength. Immigrants were categorized into Western and non-Western immigrants. Results Young natives and immigrants showed similar trajectories of SA/DP. A higher proportion of non-Western immigrants (20.5%) followed trajectories of high levels of unemployment (>2 annual months) compared with Western immigrants (15%) and natives (16.5%). Educational level and duration of residence in Sweden (in immigrants) discriminated trajectories of both SA/DP and unemployment, whereas psychiatric comorbidity only discriminated trajectories of SA/DP. Conclusions Differences in trajectories of unemployment between young natives and immigrants with an incident CMD were found. Educational level and psychiatric comorbidity provided information on differences between natives and immigrants and duration of residence gave information for subgroups of immigrants. [ABSTRACT FROM AUTHOR]

How do political leaders politicise welfare state "reform pressures", e.g. unemployment, ageing or globalisation, in election campaigns? Competing expectations range from no politicization at all to a clear and unbiased coupling between pressures and intended policy responses. Eighteen speeches held by prime ministerial candidates at election-year party congresses in Germany, Norway and Sweden (2000–2010) reveal an unfinished and biased problem-solution coupling. On the one hand, even in these affluent countries pressures are frequently politicised. On the other hand, leaders either cherry-pick less painful policy solutions, or refrain altogether from debating them. So, while citizens learn that the welfare state is pressured, they are not exposed to the full range of policies they increasingly have reason to expect after elections. [ABSTRACT FROM AUTHOR]

Parliamentary debates and the discussion on different law proposals are a key part of the process of policy making. We argue in this article that a high economic problem pressure in the region an MP represents will affect the MP's legislative speechmaking. We also hypothesise that parties tend to coordinate their speakers in parliament to display a cohesive profile in the domain of labour, employment and immigration issues, i.e., in issue areas which reflect redistributive policies that are highly salient for almost all parties. We evaluate our expectations based on an analysis of Swedish parliamentary debates on labour, employment and immigration policy during the period between 1994 and 2014. The findings show that parliamentary parties coordinate speechmaking: Those MPs who represent economically troubled districts are less likely to appear in plenary debates, as well as MPs who deviate programmatically from the party line. [ABSTRACT FROM AUTHOR]

Background Little is known about adolescent mental health problems, including social phobia, as risk factors for future work incapacity. The aim of this study was to investigate the association between social phobia in adolescence and unemployment and sickness absence (SA) in early adulthood, also evaluating the role of familial factors (genetics and shared environment). Methods A sample of 2845 Swedish twins born in 1985–86 in Sweden was followed longitudinally in the population-based and prospective Twin study of CHild and Adolescent Development. Information on twins' social phobia was collected at ages 13–4, 16–7 and 19–20 years. Logistic regression providing odds ratios (OR) with 95% confidence intervals (95% CI) was used to analyze the associations between social phobia, unemployment and SA during the follow-up 2006–12. The influence of familial factors was evaluated by conditional logistic regression. Results Presence of social phobia during adolescence was associated with increased odds for unemployment and SA in young adulthood. For unemployment, the highest OR was at the age of 13–4 years (1.58 [95% CI: 1.22–2.06]), and the associations became null after adjusting for familial factors. For SA, the highest OR was at the age of 19–20 years (1.73 [95% CI: 1.13–2.65]), and the estimates changed slightly after adjusting for familial factors. Conclusions : Results suggest that social phobia experienced in adolescence contribute to early adulthood unemployment and SA. Familial factors seemed to explain the association between social phobia and unemployment. [ABSTRACT FROM AUTHOR]

Background: Father's health is important for mothers and unborn/newborn children and knowledge about expectant fathers' health in relation to lifestyle and psychosocial aspects is essential. Aims: To determine sociodemographic and lifestyle factors, self‐reported health and sense of coherence among fathers and partners in relation to their risk for depression and anxiety in early pregnancy. Methods: A cross‐sectional design, descriptive statistics, chi‐squared analysis, T‐test, binary logistic regression, multiple logistic regression with OR and 95% CI were used. Results: A total of 532 prospective fathers/partners constituted the cohort (mean age 31.55, SD 5.47 years). Nearly, one in ten (9.8%) had a statistically high risk for depression; mainly those who were unemployed (p = 0.043), had financial distress (0.001), reported 'very or fairly bad' health (p = 0.002), had a 'very or fairly bad' sexual satisfaction (p = 0.006) and scored low on the SOC scale (p < 0.001). They smoked more often (p = 0.003) were hazardous users of alcohol (p = 0.001) and slept with difficulties (p = 0.001). Those with sleeping difficulties were 5.7 times more likely to have several symptoms of depression (p = 0.001). Hazardous users of alcohol and smokers had 3.1 respectively 3.0 times higher risk for depression (p = 0.001 respectively 0.003). The single strongest risk factor was a low score on the SOC‐scale which gave 10.6 (AOR 10.6; 95% CI 5.4–20.6) higher risk for depression. High‐anxiety 'just now' was reported by 8.9% and 'in general' by 7.9%, and those who had sleeping difficulties reported 'very or fairly bad' health (p < 0.001). Conclusions: Allocating more resources and introducing more family‐focused care with depression and anxiety screening in early pregnancy for both expecting parents at antenatal care should be strongly considered by actors and policymakers, as this is a step in maintaining a family's well‐being. [ABSTRACT FROM AUTHOR]

Purpose: Prior research has documented an association between unemployment and elevated suicide risk. Yet, few Swedish studies have explicitly considered how such risk may vary by different migration background characteristics among persons of foreign-origin, who often experience diverse forms of labor market marginalization. This study examines the extent to which unemployment status may differentially influence suicide risk among the foreign-origin by generational status, region of origin, age at arrival, and duration of residence.Methods: Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993 to 2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models.Results: Elevated suicide risk observed among foreign-origin unemployed groups was generally of a similar or lower magnitude than that found in unemployed native-origin, although unemployed second-generation Swedish men demonstrated significantly greater (p < 0.05) excess risk of suicide than that observed among their native-origin counterparts. Unemployed foreign-born men with a younger age at arrival and longer duration of residence demonstrated an increased risk of suicide, while those who arrived as adults, and a shorter duration of residence did not show any increased risk. Among foreign-born women, excess suicide risk persisted regardless of age at arrival and duration of residence in the long-term unemployed.Conclusions: Multiple migration background characteristics should be considered when examining relationships between employment status and suicide among the foreign-origin. [ABSTRACT FROM AUTHOR]

Background: The impact of obsessive–compulsive disorder (OCD) on objective indicators of labour market marginalisation has not been quantified. Methods: Linking various Swedish national registers, we estimated the risk of three labour market marginalisation outcomes (receipt of newly granted disability pension, long-term sickness absence and long-term unemployment) in individuals diagnosed with OCD between 2001 and 2013 who were between 16 and 64 years old at the date of the first OCD diagnosis (n = 16 267), compared with matched general population controls (n = 157 176). Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox regression models, adjusting for a number of covariates (e.g. somatic disorders) and stratifying by sex. To adjust for potential familial confounders, we further analysed data from 7905 families that included full siblings discordant for OCD. Results: Patients were more likely to receive at least one outcome of interest [adjusted HR = 3.63 (95% CI 3.53–3.74)], including disability pension [adjusted HR = 16.36 (95% CI 15.34–17.45)], being on long-term sickness absence [adjusted HR = 3.07 (95% CI 2.95–3.19)] and being on long-term unemployment [adjusted HR = 1.72 (95% CI 1.63–1.82)]. Results remained similar in the adjusted sibling comparison models. Exclusion of comorbid psychiatric disorders had a minimal impact on the results. Conclusions: Help-seeking individuals with OCD diagnosed in specialist care experience marked difficulties to participate in the labour market. The findings emphasise the need for cooperation between policy-makers, vocational rehabilitation and mental health services in order to design and implement specific strategies aimed at improving the patients' participation in the labour market. [ABSTRACT FROM AUTHOR]

Abstract Rationale Symptoms of mental health problems have been shown to predict adverse labour market outcomes including unemployment, but no studies have used sibling models to examine the relationship between clinically diagnosed psychiatric conditions in adolescence and subsequent unemployment. Objective This study used extensive Swedish registry data to investigate the link between psychiatric conditions diagnosed during military conscription and unemployment over two decades. Further, we identified whether this relation was amplified during an economic downturn and tested whether it was affected by adjustment for unobserved family characteristics using sibling fixed-effects models. Method Psychiatric conditions were diagnosed by psychologists and psychiatrists at military conscription in sample of 929,191 Swedish men (mean age = 18.4 years) between 1969 and 1989. The average number of days unemployed per year was observed from 1992 to 2012, using the records of the Swedish Public Employment Services. Results After adjustment for physical health and childhood socioeconomic status those diagnosed with any psychiatric condition experienced approximately an additional 10 days per year unemployment compared to others. Alcohol (16 days unemployment) and other substance use disorders (17 days) were the strongest predictors of exposure to future unemployment, followed by personality disorders (10 days), neurotic and adjustment conditions (nine days), and depressive disorders (six days). Family background factors accounted for approximately half of the observed relationship between mental health conditions and unemployment. Psychiatric conditions interacted with macroeconomic conditions such that those with pre-existing alcohol-related, and neurotic and adjustment disorders were disproportionately more likely to become unemployed following the 1990s crisis in Sweden. Conclusions Adolescent mental health conditions forecast an elevated risk of unemployment, which endures over the life course and is amplified in times of economic uncertainty. Investment in youth mental health services and alcohol and substance use prevention programs may yield economic benefits by reducing unemployment. Highlights • Large sample observed over two decades with adjustment for sibling fixed-effects. • Diagnosed adolescent psychiatric disorders predicted high risk of adult unemployment. • Alcohol and substance use disorders were most closely linked to adult unemployment. • Link between psychiatric disorders and unemployment was amplified during a crisis. • Investment in adolescent mental health services may yield long-run economic benefits. [ABSTRACT FROM AUTHOR]

Background: Although the association between low socioeconomic status and non-communicable diseases is well established, the effect of socioeconomic factors on many infectious diseases is less clear, particularly in high-income countries. We examined the associations between socioeconomic characteristics and 29 infections in Sweden.Methods: We did an individually matched case-control study in Sweden. We defined a case as a person aged 18-65 years who was notified with one of 29 infections between 2005 and 2014, in Sweden. Cases were individually matched with respect to sex, age, and county of residence with five randomly selected controls. We extracted the data on the 29 infectious diseases from the electronic national register of notified infections and infectious diseases (SmiNet). We extracted information on country of birth, educational and employment status, and income of cases and controls from Statistics Sweden's population registers. We calculated adjusted matched odds ratios (amOR) using conditional logistic regression to examine the association between infections or groups of infections and place of birth, education, employment, and income.Findings: We included 173 729 cases notified between Jan 1, 2005, and Dec 31, 2014 and 868 645 controls. Patients with invasive bacterial diseases, blood-borne infectious diseases, tuberculosis, and antibiotic-resistant infections were more likely to be unemployed (amOR 1·59, 95% CI 1·49-1·70; amOR 3·62, 3·48-3·76; amOR 1·88, 1·65-2·14; and amOR 1·73, 1·67-1·79, respectively), to have a lower educational attainment (amOR 1·24, 1·15-1·34; amOR 3·63, 3·45-3·81; amOR 2·14, 1·85-2·47; and amOR 1·07, 1·03-1·12, respectively), and to have a lowest income (amOR 1·52, 1·39-1·66; amOR 3·64, 3·41-3·89; amOR 3·17, 2·49-4·04; and amOR 1·2, 1·14-1·25, respectively). By contrast, patients with food-borne and water-borne infections were less likely than controls to be unemployed (amOR 0·74, 95% CI 0·72-0·76), to have lower education (amOR 0·75, 0·73-0·77), and lowest income (amOR 0·59, 0·58-0·61).Interpretation: These findings indicate persistent socioeconomic inequalities in infectious diseases in an egalitarian high-income country with universal health care. We recommend using these findings to identify priority interventions and as a baseline to monitor programmes addressing socioeconomic inequalities in health.Funding: The Public Health Agency of Sweden. [ABSTRACT FROM AUTHOR]

Background The association between exposure to unemployment and increased risk of mortality is well established. Yet migrants and their children often experience a number of stressors in the country of residence which could exacerbate the negative effects of job loss or unemployment. This study examined the extent to which region of origin and generational status modified associations between employment status and risk of all-cause mortality. Methods Using population-based registers, an open cohort of 2 178 321 individuals aged 25–64 years was followed from 1993 to 2008. Hazard ratios for mortality were calculated using Cox regression. Employment status and socio-demographic covariates were included as time-varying variables in all models. Results Relative to employed native-origin Swedes, excess risk of mortality was found among most groups of unemployed persons. The excess risk of mortality found among African women exposed to long-term unemployment (HR = 3.26, 95% CI: 2.30–4.63), Finnish men exposed to short-and long-term unemployment (HR = 2.74, 95% CI: 2.32–3.24 and HR = 2.39, 95% CI: 2.12–2.69), and second generation Swedish men exposed to short-term unemployment (HR = 2.34, 95% CI: 2.06–2.64) was significantly greater (P < 0.05) than that found among their unemployed native-origin counterparts. Excess risk of mortality among the unemployed in other foreign-origin groups was of a similar or lower magnitude to that found in unemployed native-origin Swedes. A decreased risk of mortality was observed among the employed in nearly all foreign-origin groups. Conclusions With some exceptions, mortality risk in foreign-origin individuals across all categories of employment status was generally similar to or lower than the risk observed in native-origin Swedes. [ABSTRACT FROM AUTHOR]

Objective: There is a presumption that hospital readmission rates amongst persons aged ≥65 years are mainly dependent on the quality of care. In this study, our primary aim was to explore the association between 30-day hospital readmission for patients aged ≥65 years and socioeconomic characteristics of the studied population. A secondary aim was to explore the association between self-reported lack of strategies for working with older patients at primary health care centres and early readmission. Design: A cross-sectional ecological study and an online questionnaire sent to the heads of the primary health care centres. We performed correlation and regression analyses. Setting and subjects: Register data of 283,063 patients in 29 primary health care centres in the Region Örebro County (Sweden) in 2014. Main outcome measure: Thirty-day hospital readmission rates for patients aged ≥65 years. Covariates were socioeconomic characteristics among patients registered at the primary health care centre and eldercare workload. Results: Early hospital readmission was found to be associated with low socioeconomic status of the studied population: proportion foreign-born (r = 0.74; p < 0.001), proportion unemployed (r = 0.73; p < 0.001), Care Need Index (r = 0.74; p < 0.001), sick leave rate (r = 0.51; p < 0.01) and average income (r = −0.40; p = 0.03). The proportion of unemployed alone could explain up to 71.4% of the variability in hospital readmission (p < 0.001). Primary health care centres reporting lack of strategies to prevent readmissions in older patients did not have higher hospital readmission rates than those reporting they had such strategies. Conclusion: Primary health care centres localized in neighbourhoods with low socioeconomic status had higher rates of hospital readmission for patients aged ≥65. Interventions aimed at reducing hospital readmissions for older patients should also consider socioeconomic disparities. Key Points: In Sweden, hospital readmission within 30 days among patients aged ≥65 has been used as a measure of quality of primary care for the elderly. However, in our study, elderly 30-day readmission was associated with low neighbourhood socioeconomic status. A simple survey in one Swedish region showed that the primary health care centres that lacked active strategies for working with aged patients did not have higher hospital readmission rates than those that reported having strategies. Interventions aimed at reducing elderly hospital readmissions should therefore also consider the socioeconomic disparities in the elderly. [ABSTRACT FROM AUTHOR]

A large number of studies have demonstrated that the proportion of home-owners in a region tend to be positively associated with the unemployment levels in that region. In this paper, we introduce a missing piece of explaining this commonly found pattern. By analysing individual-level population register data on Sweden, we jointly examine the effects of micro- and macro-level home-ownership on individuals' unemployment. The findings indicate that even though home-owners have a lower probability of being unemployed, there is a penalty for both renters and home-owners on unemployment in regions with high home-ownership rates. Differences in mobility patterns cannot explain this pattern. However, when labour market size is considered, the higher probability of unemployment in high home-owning regions is drastically reduced. This suggests that high home-ownership regions tend to coincide with small labour markets, affecting the job matching process negatively. [ABSTRACT FROM AUTHOR]

Background: Unemployment and alcohol use have often been found to correlate and to act as risk factors for each other. However, only few studies have examined these associations at longitudinal settings extending over several life phases. Moreover, previous studies have mostly used total consumption or medical diagnoses as the indicator, whereas subclinical measures of harmful alcohol use, such as heavy episodic drinking (HED), have been used rarely. The aim of this study was to examine the associations between HED and unemployment from adolescence to midlife in two Nordic countries. Methods: Participants of separate cohort studies from Sweden and Finland were recruited at age 16 in 1981/1983 and followed up at ages 21/22, 30/32 and 43/42, (n = 1080/2194), respectively. Cross-lagged autoregressive models were used to determine associations between HED and unemployment. Results: In the Swedish cohort, HED at ages 16 and 30 in men and HED at age 21 in women were associated with subsequent unemployment. In the Finnish cohort, we found corresponding associations at age 16 in women and at age 22 in men. However, the gender differences were not statistically significant. The associations from unemployment to HED were non-significant in both genders, in both cohorts and at all ages. Conclusions: Our results suggest that heavy drinkers are more likely to experience unemployment in subsequent years. The associations from HED to unemployment seem to exist through the life course from adolescence to midlife. More emphasis should be put on reducing alcohol related harms in order to improve labour-market outcomes. [ABSTRACT FROM AUTHOR]

Aims: This paper examines the effects of neoliberalism on health inequalities through an empirical examination of the recommodification of the social determinants of health. It uses a detailed case study of changes to three specific welfare policy domains in Sweden: unemployment, healthcare, and pensions. Methods: Using time series data from the repeat cross-sectional Swedish Living Conditions Survey for 1980–2011, it examines: (1) the effects of reductions in the replacement rate value of unemployment benefit on inequalities in self-reported general health between the employed and the unemployed; (2) the effects of reductions in the replacement rate value of pensions on educational inequalities in self-reported general health among pensioners; and (3) the effects of the increase in user charges on inequalities in having visited a doctor in the past 3 months by educational level. Results: The results suggest mixed effects of welfare state recommodification on health inequalities: inequalities increased between the Swedish employed and unemployed, yet they did not increase in the retired population, and inequalities in access to healthcare also remained steady during the study period. Conclusions: The paper concludes that the association between recommodification and health inequalities in Sweden is stronger regarding unemployment benefits than pensions or healthcare, and that this may relate to the stigmatisation of the unemployed. [ABSTRACT FROM AUTHOR]